{"hospital_name":"Hospital Metropolitano Dr Susoni","last_updated_on":"2025-04-10","version":"3.0.0","location_name":["Hospital Metropolitano Dr Susoni"],"hospital_address":["Calle Palma 55, Arecibo, PR 00612"],"type_2_npi":[""],"license_information":{"license_number":"32","state":"PR"},"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","attester_name":"","confirm_attestation":true},"standard_charge_information":[{"description":"CAT Scan of Abdomen and Pelvis With Contrast","code_information":[ { "code": "74177", "type": "CPT" } ],"standard_charges":[{"minimum":143.5200,"maximum":467.5000,"gross_charge":585.0000,"discounted_cash":585.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":467.5000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":450.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":177.4700,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":177.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":427.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":231.9000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":200.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":146.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":231.9000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":337.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":143.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":225.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":177.4700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Head or Brain Without Contrast","code_information":[ { "code": "70450", "type": "CPT" } ],"standard_charges":[{"minimum":58.4200,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":97.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":85.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":85.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":74.3900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":131.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":58.4200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":74.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":128.0200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":66.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":75.0300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":85.6700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Pelvis With Contrast","code_information":[ { "code": "72193", "type": "CPT" } ],"standard_charges":[{"minimum":99.7000,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":149.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":150.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":150.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":178.9100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":113.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":178.9100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":147.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":99.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":178.9100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":150.2500,"methodology":"fee schedule"}]}]},{"description":"Complete Ultrasound of Abdomen","code_information":[ { "code": "76700", "type": "CPT" } ],"standard_charges":[{"minimum":37.5000,"maximum":125.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":92.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":67.2100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":43.9400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":67.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":74.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":55.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":82.7400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":59.2600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":50.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":84.8200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":67.2100,"methodology":"fee schedule"}]}]},{"description":"Diagnostic Exam of Esophagus, Stomach and Small Bowel Using Endoscope Inserted Through Mouth","code_information":[ { "code": "43235", "type": "CPT" } ],"standard_charges":[{"minimum":88.0000,"maximum":454.0400,"gross_charge":120.0000,"discounted_cash":120.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":88.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":166.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":454.0400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":88.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":166.0000,"methodology":"fee schedule"}]}]},{"description":"Diagnostic Mammogram of Both Breasts","code_information":[ { "code": "77066", "type": "CPT" } ],"standard_charges":[{"minimum":37.5000,"maximum":123.6100,"gross_charge":122.0000,"discounted_cash":122.0000,"setting":"outpatient","payers_information":[{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":85.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":121.2100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":108.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":61.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":78.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":123.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":121.2100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":63.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":123.6100,"methodology":"fee schedule"}]}]},{"description":"Diagnostic Mammogram of One Breast","code_information":[ { "code": "77065", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":96.7900,"gross_charge":110.0000,"discounted_cash":110.0000,"setting":"outpatient","payers_information":[{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":66.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":94.7100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":87.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":61.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":96.7900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":94.7100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":32.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":96.7900,"methodology":"fee schedule"}]}]},{"description":"Exam of Entire Large Intestine with Biopsy Using Colonoscope","code_information":[ { "code": "45380", "type": "CPT" } ],"standard_charges":[{"minimum":125.0000,"maximum":569.4000,"gross_charge":410.0000,"discounted_cash":410.0000,"setting":"outpatient","payers_information":[{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":127.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":166.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":569.4000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":166.0000,"methodology":"fee schedule"}]}]},{"description":"Exam of Esophagus, Stomach, and Upper Small Intestine with Biopsy Using Endoscope Inserted Through Mouth","code_information":[ { "code": "43239", "type": "CPT" } ],"standard_charges":[{"minimum":88.0000,"maximum":405.4800,"gross_charge":130.0000,"discounted_cash":130.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":88.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":127.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":166.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":145.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":163.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":119.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":405.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.0000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":88.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":166.0000,"methodology":"fee schedule"}]}]},{"description":"External Ultrasound of Pregnant Uterus in 2nd or 3rd Trimester","code_information":[ { "code": "76805", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":125.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":87.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":67.2100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":67.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":80.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":106.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":63.5400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":80.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":50.0900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":54.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":65.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":67.2100,"methodology":"fee schedule"}]}]},{"description":"Individual Physical Therapy Exercises","code_information":[ { "code": "97110", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":25.5600,"gross_charge":38.0000,"discounted_cash":38.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.5600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Basic Metabolic Panel with Total Calcium","code_information":[ { "code": "80048", "type": "CPT" } ],"standard_charges":[{"minimum":9.1500,"maximum":40.0000,"gross_charge":33.0000,"discounted_cash":33.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.8300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.5800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.5200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.1500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Cholesterol Panel","code_information":[ { "code": "80061", "type": "CPT" } ],"standard_charges":[{"minimum":18.7200,"maximum":60.0000,"gross_charge":187.0000,"discounted_cash":187.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.7200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":39.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.1900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.1900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.1400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.1900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Complete Blood Cell Count With White Blood Cell Percentage","code_information":[ { "code": "85025", "type": "CPT" } ],"standard_charges":[{"minimum":8.0000,"maximum":11.1400,"gross_charge":27.0000,"discounted_cash":27.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":10.8600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.6100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":10.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.6100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.5700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.5900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.1400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Comprehensive Metabolic Panel","code_information":[ { "code": "80053", "type": "CPT" } ],"standard_charges":[{"minimum":13.0400,"maximum":55.0000,"gross_charge":41.0000,"discounted_cash":41.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.7700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":13.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Prostate Specific Antigen Level","code_information":[ { "code": "84154", "type": "CPT" } ],"standard_charges":[{"minimum":13.1700,"maximum":145.0000,"gross_charge":160.0000,"discounted_cash":160.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":145.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.1700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.3400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of COVID-19 Virus DNA Using Amplified Probe Technique","code_information":[ { "code": "87635", "type": "CPT" } ],"standard_charges":[{"minimum":51.3300,"maximum":76.3300,"gross_charge":175.0000,"discounted_cash":175.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Auxilio Platino","plan_name":"Auxilio Platino Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Crown Life Ins Co.","plan_name":"Crown Life Ins Co. Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Life Link","plan_name":"Life Link Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":76.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":76.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":65.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"United Health Care","plan_name":"United Health Care Commercial","standard_charge_dollar":51.3300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":51.3300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Kidney Function Panel","code_information":[ { "code": "80069", "type": "CPT" } ],"standard_charges":[{"minimum":11.4800,"maximum":53.0000,"gross_charge":21.0000,"discounted_cash":21.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":12.1300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":12.2100,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":12.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.4800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Liver Function Panel","code_information":[ { "code": "80076", "type": "CPT" } ],"standard_charges":[{"minimum":9.1500,"maximum":35.0000,"gross_charge":267.0000,"discounted_cash":267.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.4200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.6000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":28.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.1500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.5800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.3300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.1500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Machine Analysis of Urine By Dipstick with Microscope Evaluation","code_information":[ { "code": "81001", "type": "CPT" } ],"standard_charges":[{"minimum":4.3200,"maximum":8.0000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.7800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.3200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.5400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Manual Analysis of Urine By Dipstick","code_information":[ { "code": "81002", "type": "CPT" } ],"standard_charges":[{"minimum":3.3000,"maximum":4.0000,"gross_charge":4.0000,"discounted_cash":4.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":3.3000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":3.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":3.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.6600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Manual Analysis of Urine By Dipstick With Microscope Evaluation","code_information":[ { "code": "81000", "type": "CPT" } ],"standard_charges":[{"minimum":4.0200,"maximum":7.7500,"gross_charge":8.0000,"discounted_cash":8.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.5400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Prothrombin Time","code_information":[ { "code": "85610", "type": "CPT" } ],"standard_charges":[{"minimum":4.8500,"maximum":12.0000,"gross_charge":20.0000,"discounted_cash":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.6200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thromboplastin Time","code_information":[ { "code": "85730", "type": "CPT" } ],"standard_charges":[{"minimum":8.0000,"maximum":14.0000,"gross_charge":30.0000,"discounted_cash":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.3800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.6000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.9500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.1900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.1900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.3000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.1800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thyroid Stimulating Hormone Level","code_information":[ { "code": "84443", "type": "CPT" } ],"standard_charges":[{"minimum":20.7500,"maximum":41.6300,"gross_charge":83.0000,"discounted_cash":83.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":24.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":24.0600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":24.0600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":23.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":24.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":24.0600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.0300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":24.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.7500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":24.0600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Prostate Specific Antigen Level","code_information":[ { "code": "84153", "type": "CPT" } ],"standard_charges":[{"minimum":22.0000,"maximum":58.0000,"gross_charge":35.0000,"discounted_cash":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":58.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.3400,"methodology":"fee schedule"}]}]},{"description":"MRI of Brain With and Without Contrast","code_information":[ { "code": "70553", "type": "CPT" } ],"standard_charges":[{"minimum":188.2700,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":637.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":361.9400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":310.3400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":310.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":737.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":261.2900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":329.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":188.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":261.2900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":290.3600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":231.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":270.4200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":310.3400,"methodology":"fee schedule"}]}]},{"description":"MRI of Leg Joint Without Contrast","code_information":[ { "code": "73721", "type": "CPT" } ],"standard_charges":[{"minimum":104.9800,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":145.8700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":145.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":168.0200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":104.9800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":168.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":234.8000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":144.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":173.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":145.8700,"methodology":"fee schedule"}]}]},{"description":"MRI of Lower Spinal Canal Without Contrast","code_information":[ { "code": "72148", "type": "CPT" } ],"standard_charges":[{"minimum":119.3800,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":149.1500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":292.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":119.3800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":149.1500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":257.8900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":146.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":154.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":210.0000,"methodology":"fee schedule"}]}]},{"description":"Outpatient Clinic Visit New Patient Level 3","code_information":[ { "code": "99203", "type": "CPT" } ],"standard_charges":[{"minimum":60.0000,"maximum":114.1000,"gross_charge":85.0000,"discounted_cash":85.0000,"setting":"outpatient","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":114.1000,"methodology":"fee schedule"}]}]},{"description":"Screening Mammogram","code_information":[ { "code": "77067", "type": "CPT" } ],"standard_charges":[{"minimum":32.5000,"maximum":102.2200,"gross_charge":110.0000,"discounted_cash":110.0000,"setting":"outpatient","payers_information":[{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":70.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":100.1600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":67.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":51.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":64.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":102.2200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":100.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":56.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":32.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":102.2200,"methodology":"fee schedule"}]}]},{"description":"Ultrasound of Non-Pregnant Uterus","code_information":[ { "code": "76830", "type": "CPT" } ],"standard_charges":[{"minimum":29.9600,"maximum":125.0000,"gross_charge":65.0000,"discounted_cash":65.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":68.6000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":64.4700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":29.9600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":53.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":29.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":47.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":87.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":88.9100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":45.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":88.9100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":55.9100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":47.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":90.2600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":29.9600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Back, Minimum of 4 Views","code_information":[ { "code": "72110", "type": "CPT" } ],"standard_charges":[{"minimum":14.3500,"maximum":48.0000,"gross_charge":134.0000,"discounted_cash":134.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":24.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":46.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":23.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":22.2000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":31.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":35.9200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":22.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":35.9200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.3600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":35.9200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":23.3800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Eye To Detect Foreign Body","code_information":[ { "code": "70030", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":32.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.7400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.0900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.6200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Jaw, 4 or More Views","code_information":[ { "code": "70110", "type": "CPT" } ],"standard_charges":[{"minimum":10.5000,"maximum":40.0000,"gross_charge":134.0000,"discounted_cash":134.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":34.5000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":27.9400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.9400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":34.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.9400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.2300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mastoid Processes of Skull, 1-3 Views","code_information":[ { "code": "70120", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":31.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.3600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Face Bones, 1-2 Views","code_information":[ { "code": "70140", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":31.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.1600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.6800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.7700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":20.6800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.0700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.1600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Face Bones, 3 or More Views","code_information":[ { "code": "70150", "type": "CPT" } ],"standard_charges":[{"minimum":11.9000,"maximum":40.0000,"gross_charge":107.0000,"discounted_cash":107.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":20.8500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.0800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.8400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.0300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":30.8400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.9600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":30.8400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.0800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Nose Bones","code_information":[ { "code": "70160", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":27.0000,"gross_charge":76.0000,"discounted_cash":76.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.6500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.6200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Both Eyes, 4 or More Views","code_information":[ { "code": "70200", "type": "CPT" } ],"standard_charges":[{"minimum":11.9000,"maximum":41.0000,"gross_charge":112.0000,"discounted_cash":112.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":20.8500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.0800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":20.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":19.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.0800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Paranasal Sinuses, 1-2 Views","code_information":[ { "code": "70210", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":30.0000,"gross_charge":112.0000,"discounted_cash":112.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":15.7700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.4900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.8700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.1900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.7700,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Paranasal Sinuses, 3 or More Views","code_information":[ { "code": "70220", "type": "CPT" } ],"standard_charges":[{"minimum":11.9000,"maximum":40.0000,"gross_charge":123.0000,"discounted_cash":123.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.7700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.4300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.2900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.7700,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Skull Bones, 1-3 Views","code_information":[ { "code": "70250", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":34.0000,"gross_charge":112.0000,"discounted_cash":112.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.5600,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.8300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.6000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.6200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Skull Bones, 4 or More Views","code_information":[ { "code": "70260", "type": "CPT" } ],"standard_charges":[{"minimum":13.3000,"maximum":47.0000,"gross_charge":123.0000,"discounted_cash":123.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":13.3000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":21.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":47.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":20.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.0500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":30.4800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.3100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of One Side of Jaw Joint","code_information":[ { "code": "70328", "type": "CPT" } ],"standard_charges":[{"minimum":5.9500,"maximum":27.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.9500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.8600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.2600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Both Sides of Jaw Joint","code_information":[ { "code": "70330", "type": "CPT" } ],"standard_charges":[{"minimum":8.0000,"maximum":40.0000,"gross_charge":134.0000,"discounted_cash":134.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.4600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":17.5800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":37.7400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":22.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":37.7400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":17.6900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":37.7400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.4600,"methodology":"fee schedule"}]}]},{"description":"MRI of Jaw Joint","code_information":[ { "code": "70336", "type": "CPT" } ],"standard_charges":[{"minimum":126.2200,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":200.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":277.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":200.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":232.2500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":126.2200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":232.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":254.4500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":146.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":232.2500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":200.3100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Soft Tissue of The Neck","code_information":[ { "code": "70360", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":24.0000,"gross_charge":60.0000,"discounted_cash":60.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.9700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Salivary Gland With Contrast Injection","code_information":[ { "code": "70390", "type": "CPT" } ],"standard_charges":[{"minimum":10.5000,"maximum":100.0000,"gross_charge":98.0000,"discounted_cash":98.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":58.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":57.9800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":20.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":57.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":85.6400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":44.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":85.6400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":29.4700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":37.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":85.6400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":57.9800,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Head or Brain With Contrast","code_information":[ { "code": "70460", "type": "CPT" } ],"standard_charges":[{"minimum":79.2400,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":126.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":111.9600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":111.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":282.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":108.5100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":79.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":108.5100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":137.5700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":87.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":108.7500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":111.9600,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Head or Brain With and Without Contrast","code_information":[ { "code": "70470", "type": "CPT" } ],"standard_charges":[{"minimum":86.8500,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":132.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":108.7300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":108.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":129.9200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":86.8500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":129.9200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":138.2900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":93.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":130.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":108.7300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Eye, Ear, or Sella Turcica Without Contrast","code_information":[ { "code": "70480", "type": "CPT" } ],"standard_charges":[{"minimum":86.7400,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":107.1000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":130.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":117.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":117.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":227.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":113.5900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":86.7400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":113.5900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":140.6200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":92.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":113.5900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.5000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Eye, Ear, or Sella Turcica With Contrast","code_information":[ { "code": "70481", "type": "CPT" } ],"standard_charges":[{"minimum":112.0400,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":192.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":175.6300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":175.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":282.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":112.0400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":156.2000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":125.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":175.6300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Eye, Ear, or Sella Turcica With and Without Contrast","code_information":[ { "code": "70482", "type": "CPT" } ],"standard_charges":[{"minimum":126.0900,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":218.6300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":197.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":197.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":126.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":162.3300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":140.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":197.3100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Facial Bones Without Contrast","code_information":[ { "code": "70486", "type": "CPT" } ],"standard_charges":[{"minimum":75.4900,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":130.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":117.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":117.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":97.9800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":131.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":75.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":97.9800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":139.1600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":89.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":98.6000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":117.5000,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Facial Bones With Contrast","code_information":[ { "code": "70487", "type": "CPT" } ],"standard_charges":[{"minimum":93.5300,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":161.6300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":146.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":146.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":112.8600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":93.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":112.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":148.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":108.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":112.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":146.3300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Facial Bones With and Without Contrast","code_information":[ { "code": "70488", "type": "CPT" } ],"standard_charges":[{"minimum":115.6400,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":200.6300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":180.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":180.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":142.6200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":115.6400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":142.6200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":157.9200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":130.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":142.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":180.9300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Soft Tissue of the Neck Without Contrast","code_information":[ { "code": "70490", "type": "CPT" } ],"standard_charges":[{"minimum":82.7900,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":123.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":110.8100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":110.8100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":101.9700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":82.7900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":101.9700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":138.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":89.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":101.9700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":110.8100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Soft Tissue of the Neck With Contrast","code_information":[ { "code": "70491", "type": "CPT" } ],"standard_charges":[{"minimum":98.5500,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":154.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":138.9500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":138.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":135.7200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":98.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":135.7200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":147.0700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":107.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":137.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":138.9500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Soft Tissue of the Neck With and Without Contrast","code_information":[ { "code": "70492", "type": "CPT" } ],"standard_charges":[{"minimum":115.7200,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":192.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":172.6300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":172.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":166.2100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":160.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":115.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.2100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":156.1600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":127.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":166.2100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":172.6300,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels in Head With Contrast","code_information":[ { "code": "70496", "type": "CPT" } ],"standard_charges":[{"minimum":210.2500,"maximum":210.2500,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":210.2500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels in Neck With Contrast","code_information":[ { "code": "70498", "type": "CPT" } ],"standard_charges":[{"minimum":123.0000,"maximum":330.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":123.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":165.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":146.0000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":209.5200,"methodology":"fee schedule"}]}]},{"description":"MRI of Face or Neck Without Contrast","code_information":[ { "code": "70540", "type": "CPT" } ],"standard_charges":[{"minimum":139.0700,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":229.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":229.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":201.0700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":139.0700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":201.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":262.3500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":143.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":201.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":229.3800,"methodology":"fee schedule"}]}]},{"description":"MRI of Face or Neck With Contrast","code_information":[ { "code": "70542", "type": "CPT" } ],"standard_charges":[{"minimum":160.6200,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":552.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":295.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":262.8200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":262.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":601.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":238.7800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":238.7800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":277.4600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":182.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":238.7800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":262.8200,"methodology":"fee schedule"}]}]},{"description":"MRI of Face or Neck With and Without Contrast","code_information":[ { "code": "70543", "type": "CPT" } ],"standard_charges":[{"minimum":180.3300,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":552.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":361.9400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":317.9600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":317.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":638.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":295.0400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":180.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":295.0400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":303.3000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":227.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":295.0400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":317.9600,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Head With Contrast","code_information":[ { "code": "70545", "type": "CPT" } ],"standard_charges":[{"minimum":153.6400,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":271.8200,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":271.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":400.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":220.2800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":153.6400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":220.2800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":220.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":271.8200,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Head With and Without Contrast","code_information":[ { "code": "70546", "type": "CPT" } ],"standard_charges":[{"minimum":176.8600,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":341.1200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":176.8600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":341.1200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":341.1200,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Neck Without Contrast","code_information":[ { "code": "70547", "type": "CPT" } ],"standard_charges":[{"minimum":139.8900,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":235.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":223.5400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":139.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":223.5400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":246.8600,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Neck With Contrast","code_information":[ { "code": "70548", "type": "CPT" } ],"standard_charges":[{"minimum":164.3500,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":295.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":295.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":236.6100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":164.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":236.6100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":236.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":295.3500,"methodology":"fee schedule"}]}]},{"description":"MRI of Brain With Contrast","code_information":[ { "code": "70552", "type": "CPT" } ],"standard_charges":[{"minimum":158.6100,"maximum":725.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":446.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":295.4800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":272.2800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":272.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":725.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":229.3500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":290.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":158.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":229.3500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":282.9200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":186.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":237.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":272.2800,"methodology":"fee schedule"}]}]},{"description":"Mapping of Functional Brain Activity Using MRI","code_information":[ { "code": "70554", "type": "CPT" } ],"standard_charges":[{"minimum":169.3100,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":241.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":438.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":341.1200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":169.3100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":341.1200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":341.1200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Chest, 1 View","code_information":[ { "code": "71045", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":38.0800,"gross_charge":56.0000,"discounted_cash":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":38.0800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.1400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":23.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.8700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":38.0800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Chest, 2 Views","code_information":[ { "code": "71046", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":25.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.5500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.5100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.6700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Chest, 3 Views","code_information":[ { "code": "71047", "type": "CPT" } ],"standard_charges":[{"minimum":17.4800,"maximum":41.5000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":34.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":41.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Chest, 4 or More Views","code_information":[ { "code": "71048", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":71.5000,"gross_charge":157.0000,"discounted_cash":157.0000,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":44.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":27.2100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":62.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":21.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":21.1700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.2100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":71.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.2100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs on One Side, 2 Views","code_information":[ { "code": "71100", "type": "CPT" } ],"standard_charges":[{"minimum":9.8000,"maximum":31.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":15.0800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.5800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.5800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.8100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.5800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.0800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs one On Side and Chest, 3 or More Views","code_information":[ { "code": "71101", "type": "CPT" } ],"standard_charges":[{"minimum":14.0000,"maximum":35.0000,"gross_charge":44.0000,"discounted_cash":44.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":16.1600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.1200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.5400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs on Both Sides, 3 or More Views","code_information":[ { "code": "71110", "type": "CPT" } ],"standard_charges":[{"minimum":11.9000,"maximum":40.0000,"gross_charge":101.0000,"discounted_cash":101.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.7300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.2300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Ribs on Both Sides and Chest, 4 or More Views","code_information":[ { "code": "71111", "type": "CPT" } ],"standard_charges":[{"minimum":12.2500,"maximum":46.0000,"gross_charge":55.0000,"discounted_cash":55.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":12.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.9300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":46.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":33.0200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":22.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":33.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.9600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":46.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":33.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.3800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Breastbone","code_information":[ { "code": "71120", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":27.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":15.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.5800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.3100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Shoulder Joint Without Contrast","code_information":[ { "code": "71130", "type": "CPT" } ],"standard_charges":[{"minimum":9.8000,"maximum":32.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.5400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Chest Without Contrast","code_information":[ { "code": "71250", "type": "CPT" } ],"standard_charges":[{"minimum":72.9500,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":125.8600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":111.0400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":111.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":101.9700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":131.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":72.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":101.9700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":136.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":85.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":106.9400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":111.0400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Chest With Contrast","code_information":[ { "code": "71260", "type": "CPT" } ],"standard_charges":[{"minimum":93.3800,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":157.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":139.6400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":139.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":136.4500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":93.3800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":136.4500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":145.7600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":105.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":137.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":139.6400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Chest With and Without Contrast","code_information":[ { "code": "71270", "type": "CPT" } ],"standard_charges":[{"minimum":112.1900,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":197.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":173.7800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":173.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":166.5700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":112.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":166.5700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":155.7200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":128.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":170.0100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":173.7800,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels in Chest With Contrast","code_information":[ { "code": "71275", "type": "CPT" } ],"standard_charges":[{"minimum":140.9900,"maximum":330.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":230.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":140.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":230.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":230.2200,"methodology":"fee schedule"}]}]},{"description":"MRI of Chest Without Contrast","code_information":[ { "code": "71550", "type": "CPT" } ],"standard_charges":[{"minimum":140.4600,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":376.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":229.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":229.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":231.9000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":140.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":231.9000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":263.9100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":146.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":231.9000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":229.3800,"methodology":"fee schedule"}]}]},{"description":"MRI of Chest With Contrast","code_information":[ { "code": "71551", "type": "CPT" } ],"standard_charges":[{"minimum":180.9000,"maximum":675.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":552.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":295.4800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":303.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":303.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":675.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":369.0700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":180.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":369.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":292.4000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":185.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":369.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":303.1900,"methodology":"fee schedule"}]}]},{"description":"MRI of Chest With and Without Contrast","code_information":[ { "code": "71552", "type": "CPT" } ],"standard_charges":[{"minimum":226.5300,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":552.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":361.9400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":372.4000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":372.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":388.6600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":226.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":388.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":323.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":229.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":388.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":372.4000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of CD4 White Blood T Cells","code_information":[ { "code": "86361", "type": "CPT" } ],"standard_charges":[{"minimum":36.4700,"maximum":69.3800,"gross_charge":56.0000,"discounted_cash":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":37.4100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":38.3500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":69.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":38.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":38.3500,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":37.4100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":38.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":38.3500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":36.6800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":37.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":38.3500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of CD4 and CD8 White Blood T Cells With Ratio","code_information":[ { "code": "86360", "type": "CPT" } ],"standard_charges":[{"minimum":40.0000,"maximum":130.2500,"gross_charge":333.0000,"discounted_cash":333.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":65.6500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":130.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":123.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":76.1500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":65.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":67.3000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":67.3000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Back, Single View","code_information":[ { "code": "72020", "type": "CPT" } ],"standard_charges":[{"minimum":8.0000,"maximum":24.0000,"gross_charge":46.0000,"discounted_cash":46.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.1600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.6400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.6000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.6000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.8100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.6000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.1600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Neck, 2 or 3 Views","code_information":[ { "code": "72040", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":32.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.4700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.5500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.9200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Neck, 4 or 5 Views","code_information":[ { "code": "72050", "type": "CPT" } ],"standard_charges":[{"minimum":11.9000,"maximum":41.0000,"gross_charge":134.0000,"discounted_cash":134.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":11.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":26.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.1900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":22.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":29.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":21.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":41.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":22.9200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Neck, 6 or More Views","code_information":[ { "code": "72052", "type": "CPT" } ],"standard_charges":[{"minimum":16.8000,"maximum":55.0000,"gross_charge":157.0000,"discounted_cash":157.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":34.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.4500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.7200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":42.4500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":26.6800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":42.4500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":31.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid Back, 2 Views","code_information":[ { "code": "72070", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":33.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":33.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":19.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.7900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":16.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid Back, 3 Views","code_information":[ { "code": "72072", "type": "CPT" } ],"standard_charges":[{"minimum":10.5000,"maximum":34.0000,"gross_charge":45.0000,"discounted_cash":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.7000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.6200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.5400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid Back, 4 or More Views","code_information":[ { "code": "72074", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":39.0000,"gross_charge":50.0000,"discounted_cash":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":23.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":23.6100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":20.8100,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":28.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.3900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.1100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":29.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":28.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":23.6100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Mid\/Lower Back Junction","code_information":[ { "code": "72080", "type": "CPT" } ],"standard_charges":[{"minimum":7.7000,"maximum":34.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.7000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.8600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.2400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.8300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.6200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Back, 2-3 Views","code_information":[ { "code": "72100", "type": "CPT" } ],"standard_charges":[{"minimum":9.8000,"maximum":29.0000,"gross_charge":123.0000,"discounted_cash":123.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.1500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.6900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.3700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.1500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Back, Minimum of 6 Views","code_information":[ { "code": "72114", "type": "CPT" } ],"standard_charges":[{"minimum":16.0000,"maximum":64.0000,"gross_charge":81.0000,"discounted_cash":81.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":34.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":33.3000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":22.2000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":33.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":37.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.4500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":64.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.2300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":42.4500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":25.0100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":24.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":42.4500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":33.3000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Back, 2-3 Bending Views","code_information":[ { "code": "72120", "type": "CPT" } ],"standard_charges":[{"minimum":9.8000,"maximum":36.0000,"gross_charge":145.0000,"discounted_cash":145.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":22.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.5700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":16.5200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.5400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Neck Spine Without Contrast","code_information":[ { "code": "72125", "type": "CPT" } ],"standard_charges":[{"minimum":74.7300,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":127.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":112.6500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":112.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":113.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":131.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":74.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":113.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":137.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":86.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":115.2700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":112.6500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Neck Spine With Contrast","code_information":[ { "code": "72126", "type": "CPT" } ],"standard_charges":[{"minimum":104.3700,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":158.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":140.3400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":140.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":169.1100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":157.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":104.3700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":169.1100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":145.6500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":105.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":169.1100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":140.3400,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Neck Spine With and Without Contrast","code_information":[ { "code": "72127", "type": "CPT" } ],"standard_charges":[{"minimum":110.2600,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":196.4700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":174.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":174.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":110.2600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":154.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":125.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":174.2500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Mid Spine Without Contrast","code_information":[ { "code": "72128", "type": "CPT" } ],"standard_charges":[{"minimum":74.4000,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":126.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":111.9600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":111.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":113.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":74.4000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":113.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":136.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":85.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":133.4000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":111.9600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thrombin Clotting Time Test","code_information":[ { "code": "85670", "type": "CPT" } ],"standard_charges":[{"minimum":4.0000,"maximum":16.8800,"gross_charge":112.0000,"discounted_cash":112.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.0700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.1800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.2700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.2700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Screening for Sickle Cell Anemia","code_information":[ { "code": "85660", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":25.0000,"gross_charge":28.0000,"discounted_cash":28.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.7100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.4300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.8500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor X Using Diluted Russell Viper Venom","code_information":[ { "code": "85613", "type": "CPT" } ],"standard_charges":[{"minimum":5.5500,"maximum":75.0000,"gross_charge":93.0000,"discounted_cash":93.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.3700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":13.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.5500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.3300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Evaluation of Blood Clotting or Dissolving Function","code_information":[ { "code": "85397", "type": "CPT" } ],"standard_charges":[{"minimum":32.2900,"maximum":37.0000,"gross_charge":350.0000,"discounted_cash":350.0000,"setting":"outpatient","payers_information":[{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":32.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":32.2900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Quantitative D-Dimer Test","code_information":[ { "code": "85379", "type": "CPT" } ],"standard_charges":[{"minimum":7.7400,"maximum":180.0000,"gross_charge":180.0000,"discounted_cash":180.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.2200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":18.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.7400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":14.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.6100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clot Dissolving Activity Using Agglutination Slide","code_information":[ { "code": "85362", "type": "CPT" } ],"standard_charges":[{"minimum":9.6200,"maximum":40.0000,"gross_charge":56.0000,"discounted_cash":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.6200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":33.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":36.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":17.4300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.8600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.8600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clot Formation Time Using Lee and White Method","code_information":[ { "code": "85345", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":7.0000,"gross_charge":33.0000,"discounted_cash":33.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":4.5500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.1600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.1600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Free Protein S Blood Clotting Inhibitor Level","code_information":[ { "code": "85306", "type": "CPT" } ],"standard_charges":[{"minimum":14.0100,"maximum":125.0000,"gross_charge":253.0000,"discounted_cash":253.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":82.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":21.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.0100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.5600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Total Protein S Blood Clotting Inhibitor Level","code_information":[ { "code": "85305", "type": "CPT" } ],"standard_charges":[{"minimum":14.2500,"maximum":126.2400,"gross_charge":131.0000,"discounted_cash":131.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.2000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":126.2400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":39.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":24.3100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":126.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.6100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Protein C Blood Clotting Inhibitor Activity","code_information":[ { "code": "85303", "type": "CPT" } ],"standard_charges":[{"minimum":17.5000,"maximum":150.0000,"gross_charge":206.0000,"discounted_cash":206.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":56.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":51.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.8100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Protein C Blood Clotting Inhibitor Antigen","code_information":[ { "code": "85302", "type": "CPT" } ],"standard_charges":[{"minimum":16.8000,"maximum":77.0000,"gross_charge":126.0000,"discounted_cash":126.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":69.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":17.6100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":17.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.2200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Antithrombin III Blood Clotting Inhibitor Level","code_information":[ { "code": "85301", "type": "CPT" } ],"standard_charges":[{"minimum":7.7500,"maximum":75.0000,"gross_charge":95.0000,"discounted_cash":95.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.1100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":24.0500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.7500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.4900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.4900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Antithrombin III Blood Clotting Inhibitor Activity","code_information":[ { "code": "85300", "type": "CPT" } ],"standard_charges":[{"minimum":12.5300,"maximum":125.0000,"gross_charge":126.0000,"discounted_cash":126.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":64.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":58.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":74.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":74.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":27.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":64.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":12.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor, Fitzgerald Assay","code_information":[ { "code": "85293", "type": "CPT" } ],"standard_charges":[{"minimum":14.0000,"maximum":140.0000,"gross_charge":250.0000,"discounted_cash":250.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":26.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.1300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":27.1300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor XII","code_information":[ { "code": "85280", "type": "CPT" } ],"standard_charges":[{"minimum":25.2700,"maximum":100.0000,"gross_charge":195.0000,"discounted_cash":195.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":27.0400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":73.0800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":25.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":27.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor IX","code_information":[ { "code": "85250", "type": "CPT" } ],"standard_charges":[{"minimum":26.5300,"maximum":125.0000,"gross_charge":83.0000,"discounted_cash":83.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":122.9900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":89.7300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":104.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":104.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":104.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":48.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":122.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factors VIII and von Willebrand","code_information":[ { "code": "85247", "type": "CPT" } ],"standard_charges":[{"minimum":12.5300,"maximum":250.0000,"gross_charge":220.0000,"discounted_cash":220.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":32.0600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":60.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":200.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":32.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":12.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor von Willebrand Antigen","code_information":[ { "code": "85246", "type": "CPT" } ],"standard_charges":[{"minimum":12.5300,"maximum":150.0000,"gross_charge":199.0000,"discounted_cash":199.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":32.0600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":48.4300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":130.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":32.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":12.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor VIII Deficiency","code_information":[ { "code": "85240", "type": "CPT" } ],"standard_charges":[{"minimum":12.5300,"maximum":125.0000,"gross_charge":83.0000,"discounted_cash":83.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.0200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":123.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":69.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":43.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":123.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":12.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Measurement of Blood Clotting Factor V","code_information":[ { "code": "85220", "type": "CPT" } ],"standard_charges":[{"minimum":24.6600,"maximum":210.0000,"gross_charge":161.0000,"discounted_cash":161.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":24.6600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":118.9900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":82.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":110.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":48.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":24.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":118.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.2800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Automated Leukocyte White Blood Cell Count","code_information":[ { "code": "85048", "type": "CPT" } ],"standard_charges":[{"minimum":2.0000,"maximum":22.4300,"gross_charge":10.0000,"discounted_cash":10.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":3.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.6400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.6400,"methodology":"fee schedule"},{"payer_name":"Corvel Network","plan_name":"Corvel Network Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.6400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":3.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.6400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.6400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":3.4000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":3.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.4300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.6400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Immature Red Blood Cell Count","code_information":[ { "code": "85045", "type": "CPT" } ],"standard_charges":[{"minimum":2.8700,"maximum":10.0000,"gross_charge":17.0000,"discounted_cash":17.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.7400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.7400,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.7400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.7400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":2.8700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.4500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.7400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Hemoglobin Blood Count","code_information":[ { "code": "85018", "type": "CPT" } ],"standard_charges":[{"minimum":2.0000,"maximum":6.5500,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":2.6100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.4800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":3.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":2.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.3900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Red Blood Cell Volume","code_information":[ { "code": "85014", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":6.5500,"gross_charge":7.0000,"discounted_cash":7.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.0500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":3.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":3.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":3.3900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Examination of White Blood Cells Using Microscope","code_information":[ { "code": "85008", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":17.0000,"gross_charge":10.0000,"discounted_cash":10.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":4.8100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":3.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.7200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.6800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.9300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Bleeding Time","code_information":[ { "code": "85002", "type": "CPT" } ],"standard_charges":[{"minimum":2.0000,"maximum":12.0000,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":4.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.4500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.2300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.7900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.4500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Pregnancy Hormone Identification","code_information":[ { "code": "84703", "type": "CPT" } ],"standard_charges":[{"minimum":10.2400,"maximum":25.0000,"gross_charge":50.0000,"discounted_cash":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.7600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":24.2000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":10.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":10.7600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.8800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.2400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":10.7600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Pregnancy Hormone Level","code_information":[ { "code": "84702", "type": "CPT" } ],"standard_charges":[{"minimum":21.0000,"maximum":54.7500,"gross_charge":75.0000,"discounted_cash":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":54.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":21.3000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.8900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.5600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Zinc Level","code_information":[ { "code": "84630", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":60.0000,"gross_charge":53.0000,"discounted_cash":53.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.9100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":45.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":47.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":47.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":45.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.5400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":10.5400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin K Level","code_information":[ { "code": "84597", "type": "CPT" } ],"standard_charges":[{"minimum":17.0000,"maximum":210.0000,"gross_charge":189.0000,"discounted_cash":189.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.1500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":29.5800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":82.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.6300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.6300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin A Level","code_information":[ { "code": "84590", "type": "CPT" } ],"standard_charges":[{"minimum":16.2000,"maximum":75.7400,"gross_charge":50.0000,"discounted_cash":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.2000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":75.7400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":34.2300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":71.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":71.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":71.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":38.3100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":75.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.6100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Urea Nitrogen Level in Blood","code_information":[ { "code": "84520", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":10.0000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":5.5100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.6500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":6.9000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.6500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.6500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.8300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.6500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Mid Spine With Contrast","code_information":[ { "code": "72129", "type": "CPT" } ],"standard_charges":[{"minimum":104.9000,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":158.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":141.0300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":141.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":170.5600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":104.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":170.5600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":145.8200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":105.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":170.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":141.0300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Reverse T3 Thyroid Hormone Level","code_information":[ { "code": "84482", "type": "CPT" } ],"standard_charges":[{"minimum":5.5100,"maximum":100.0000,"gross_charge":140.0000,"discounted_cash":140.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":22.0200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.0200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free T3 Thyroid Hormone Level","code_information":[ { "code": "84481", "type": "CPT" } ],"standard_charges":[{"minimum":23.0700,"maximum":115.0000,"gross_charge":333.0000,"discounted_cash":333.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":23.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":48.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":87.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":23.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":24.2600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":32.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":23.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":48.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":24.2600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total T3 Thyroid Hormone Level","code_information":[ { "code": "84480", "type": "CPT" } ],"standard_charges":[{"minimum":19.3100,"maximum":45.0000,"gross_charge":60.0000,"discounted_cash":60.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.4000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":21.8600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.3100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":20.3100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thyroid Hormone Uptake Analysis","code_information":[ { "code": "84479", "type": "CPT" } ],"standard_charges":[{"minimum":8.8400,"maximum":15.0000,"gross_charge":33.0000,"discounted_cash":33.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.2700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.2700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.0400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.2700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.2700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.2700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Mid Spine With and Without Contrast","code_information":[ { "code": "72130", "type": "CPT" } ],"standard_charges":[{"minimum":122.7800,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":198.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":175.4000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":175.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":122.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":154.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":126.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":175.4000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - SGPT Enzyme Level","code_information":[ { "code": "84460", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":11.0300,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.0300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.5800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.7900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.5800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - SGOT Enzyme Level","code_information":[ { "code": "84450", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":10.1800,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.4100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin E Level","code_information":[ { "code": "84446", "type": "CPT" } ],"standard_charges":[{"minimum":19.8100,"maximum":65.0000,"gross_charge":160.0000,"discounted_cash":160.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":62.7400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":51.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":26.9100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":62.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.3100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":20.3100,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Lower Spine Without Contrast","code_information":[ { "code": "72131", "type": "CPT" } ],"standard_charges":[{"minimum":72.6800,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":126.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":111.5000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":111.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":113.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":131.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":72.6800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":113.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":136.0600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":84.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":115.2700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":111.5000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Thyroxine Level","code_information":[ { "code": "84439", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":37.7500,"gross_charge":57.0000,"discounted_cash":57.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":19.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":37.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":12.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.9200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":12.9200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.9200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.4600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":19.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.2800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":12.9200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Thyroxine Level","code_information":[ { "code": "84436", "type": "CPT" } ],"standard_charges":[{"minimum":9.0000,"maximum":20.0000,"gross_charge":35.0000,"discounted_cash":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.6100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.8400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.8400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.8400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.8400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.9200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.3500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.8400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Thyroglobulin Hormone Level","code_information":[ { "code": "84432", "type": "CPT" } ],"standard_charges":[{"minimum":22.0000,"maximum":175.0000,"gross_charge":82.0000,"discounted_cash":82.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":22.4400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":39.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":82.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.2600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.0100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":23.0100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin B-1 Level","code_information":[ { "code": "84425", "type": "CPT" } ],"standard_charges":[{"minimum":29.6700,"maximum":90.0000,"gross_charge":140.0000,"discounted_cash":140.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":29.6700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":58.2800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":40.4600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":29.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":30.4100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Testosterone Level","code_information":[ { "code": "84403", "type": "CPT" } ],"standard_charges":[{"minimum":30.0000,"maximum":75.5000,"gross_charge":119.0000,"discounted_cash":119.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":36.0800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":37.6400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":36.9800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":75.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":36.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":36.9800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":36.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":36.9800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":36.9800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":40.9900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":36.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":37.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":31.8700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":36.9800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Testosterone Level","code_information":[ { "code": "84402", "type": "CPT" } ],"standard_charges":[{"minimum":35.5700,"maximum":170.0000,"gross_charge":380.0000,"discounted_cash":380.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":35.5700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":63.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":70.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":48.2400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":35.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":63.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":36.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":36.4700,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Lower Spine With Contrast","code_information":[ { "code": "72132", "type": "CPT" } ],"standard_charges":[{"minimum":91.4800,"maximum":325.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":178.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":157.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":140.5700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":161.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":140.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":169.4700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":91.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":169.4700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":145.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":105.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":169.4700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":140.5700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Sodium Level in Urine Sample","code_information":[ { "code": "84300", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":8.0000,"gross_charge":30.0000,"discounted_cash":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":6.7900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.9600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Sodium Level in Blood or Plasma Sample","code_information":[ { "code": "84295", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":8.0000,"gross_charge":30.0000,"discounted_cash":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.8900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.8900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Serotonin Hormone Level","code_information":[ { "code": "84260", "type": "CPT" } ],"standard_charges":[{"minimum":24.5300,"maximum":140.0000,"gross_charge":187.0000,"discounted_cash":187.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":43.2800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":137.2400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":111.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":138.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":135.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":55.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":43.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":137.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":24.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":24.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin B-2 Level","code_information":[ { "code": "84252", "type": "CPT" } ],"standard_charges":[{"minimum":14.5000,"maximum":225.0000,"gross_charge":247.0000,"discounted_cash":247.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":28.2800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":75.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":28.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":28.9900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":28.9900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin B-6 Level","code_information":[ { "code": "84207", "type": "CPT" } ],"standard_charges":[{"minimum":39.2500,"maximum":150.0000,"gross_charge":248.0000,"discounted_cash":248.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":39.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":149.7400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":49.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":39.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":149.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":40.2400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":40.2400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Protein Level in Body Fluid Other Than Blood","code_information":[ { "code": "84166", "type": "CPT" } ],"standard_charges":[{"minimum":12.7700,"maximum":54.0000,"gross_charge":45.0000,"discounted_cash":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":24.9200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.9300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":54.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.7700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":24.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.5400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":25.5400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Protein Level in Blood","code_information":[ { "code": "84165", "type": "CPT" } ],"standard_charges":[{"minimum":11.8600,"maximum":30.7500,"gross_charge":30.0000,"discounted_cash":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":30.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.8600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":15.3800,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Lower Spine With and Without Contrast","code_information":[ { "code": "72133", "type": "CPT" } ],"standard_charges":[{"minimum":110.2800,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":197.6300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":174.4800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":174.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":110.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":154.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":126.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":174.4800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Protein Level in Urine","code_information":[ { "code": "84156", "type": "CPT" } ],"standard_charges":[{"minimum":2.6300,"maximum":30.0000,"gross_charge":18.0000,"discounted_cash":18.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":2.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.2500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Protein Level in Blood","code_information":[ { "code": "84155", "type": "CPT" } ],"standard_charges":[{"minimum":4.0000,"maximum":10.0000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.2500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Direct Measurement of Prostate Specific Antigen Level","code_information":[ { "code": "84152", "type": "CPT" } ],"standard_charges":[{"minimum":13.1700,"maximum":100.0000,"gross_charge":166.0000,"discounted_cash":166.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.1700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":26.3400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.3400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Prolactin Hormone Level","code_information":[ { "code": "84146", "type": "CPT" } ],"standard_charges":[{"minimum":27.0800,"maximum":62.2500,"gross_charge":50.0000,"discounted_cash":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":37.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":27.0800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":62.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":27.4200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":30.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":27.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.7600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":27.7600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Progesterone Hormone Level","code_information":[ { "code": "84144", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":65.0000,"gross_charge":116.0000,"discounted_cash":116.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":29.1500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":29.8800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":58.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":29.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.8800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":29.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":29.8800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":29.8800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":29.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":38.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":28.4200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":29.8800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Alkaline Phosphatase Level","code_information":[ { "code": "84075", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":11.1000,"gross_charge":15.0000,"discounted_cash":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.3100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.4100,"methodology":"fee schedule"}]}]},{"description":"MRI of Upper Spinal Canal Without Contrast","code_information":[ { "code": "72141", "type": "CPT" } ],"standard_charges":[{"minimum":120.4800,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":209.7700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":209.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":148.7900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":243.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":120.4800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":148.7900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":259.4800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":149.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":154.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":209.7700,"methodology":"fee schedule"}]}]},{"description":"MRI of Upper Spinal Canal With Contrast","code_information":[ { "code": "72142", "type": "CPT" } ],"standard_charges":[{"minimum":153.6000,"maximum":727.5000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":446.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":295.4800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":274.3600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":274.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":727.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":235.1600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":153.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":235.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":285.6600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":189.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":235.1600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":274.3600,"methodology":"fee schedule"}]}]},{"description":"MRI of Middle Spinal Canal Without Contrast","code_information":[ { "code": "72146", "type": "CPT" } ],"standard_charges":[{"minimum":120.6000,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":210.2300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":210.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":149.1500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":120.6000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":149.1500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":259.6300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":149.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":149.1500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":210.2300,"methodology":"fee schedule"}]}]},{"description":"MRI of Middle Spinal Canal With Contrast","code_information":[ { "code": "72147", "type": "CPT" } ],"standard_charges":[{"minimum":141.7500,"maximum":727.5000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":446.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":269.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":235.1400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":235.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":727.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":233.7000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":141.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":233.7000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":272.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":176.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":240.7000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":235.1400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - LDL Cholesterol Level","code_information":[ { "code": "83721", "type": "CPT" } ],"standard_charges":[{"minimum":13.3300,"maximum":30.0000,"gross_charge":30.0000,"discounted_cash":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.3300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":13.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - VLDL Cholesterol Level","code_information":[ { "code": "83719", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":25.6300,"gross_charge":96.0000,"discounted_cash":96.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.2600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":25.6300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.8300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.6600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - HDL Cholesterol Level","code_information":[ { "code": "83718", "type": "CPT" } ],"standard_charges":[{"minimum":11.4400,"maximum":24.0000,"gross_charge":47.0000,"discounted_cash":47.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.4400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.5200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.7300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Lipase Enzyme Level","code_information":[ { "code": "83690", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":15.0000,"gross_charge":39.0000,"discounted_cash":39.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.6200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":8.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.9500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":8.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.3800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.3300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - LDH Enzyme Level","code_information":[ { "code": "83625", "type": "CPT" } ],"standard_charges":[{"minimum":12.5300,"maximum":45.0000,"gross_charge":44.0000,"discounted_cash":44.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.8800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":23.4800,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":41.6500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":18.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":17.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":12.5300,"methodology":"fee schedule"}]}]},{"description":"MRI of Lower Spinal Canal With Contrast","code_information":[ { "code": "72149", "type": "CPT" } ],"standard_charges":[{"minimum":158.9000,"maximum":727.5000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":446.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":295.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":267.6700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":267.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":727.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":231.1600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":158.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":231.1600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":281.3900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":186.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":231.1600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":267.6700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Iron Level","code_information":[ { "code": "83540", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":14.0000,"gross_charge":33.0000,"discounted_cash":33.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":9.0500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.2800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.2800,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.2800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.2800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.1400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":8.8200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.2800,"methodology":"fee schedule"}]}]},{"description":"MRI of Upper Spinal Canal With and Without Contrast","code_information":[ { "code": "72156", "type": "CPT" } ],"standard_charges":[{"minimum":172.1700,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":637.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":360.5600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":303.4200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":303.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":727.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":263.8300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":172.1700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":263.8300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":304.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":235.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":263.8300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":303.4200,"methodology":"fee schedule"}]}]},{"description":"MRI of Middle Spinal Canal With and Without Contrast","code_information":[ { "code": "72157", "type": "CPT" } ],"standard_charges":[{"minimum":164.9100,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":637.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":332.4000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":275.9700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":275.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":727.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":164.9100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":182.5800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":164.9100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":295.4100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":221.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":164.9100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":275.9700,"methodology":"fee schedule"}]}]},{"description":"MRI of Lower Spinal Canal With and Without Contrast","code_information":[ { "code": "72158", "type": "CPT" } ],"standard_charges":[{"minimum":186.4400,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":637.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":359.8600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":301.5800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":301.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":727.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":263.1000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":186.4400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":263.1000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":301.0200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":231.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":263.1000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":301.5800,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Pelvis, 1-2 Views","code_information":[ { "code": "72170", "type": "CPT" } ],"standard_charges":[{"minimum":5.2500,"maximum":27.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":12.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":24.6700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.3100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":24.6700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.6500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":9.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.9300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Pelvis, 3 or More Views","code_information":[ { "code": "72190", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":34.0000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":22.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":34.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.6900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":22.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":21.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":29.3900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":29.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":16.6700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.5500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":22.6900,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Blood Vessels of Pelvis With Contrast","code_information":[ { "code": "72191", "type": "CPT" } ],"standard_charges":[{"minimum":146.9100,"maximum":330.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":146.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2200,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Pelvis Without Contrast","code_information":[ { "code": "72192", "type": "CPT" } ],"standard_charges":[{"minimum":67.7300,"maximum":300.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":163.6300,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":118.4700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":84.0500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":138.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":84.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":275.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":92.5400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":67.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":92.5400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":130.1400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":82.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":92.5400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":84.0500,"methodology":"fee schedule"}]}]},{"description":"CAT Scan of Pelvis With and Without Contrast","code_information":[ { "code": "72194", "type": "CPT" } ],"standard_charges":[{"minimum":107.2100,"maximum":650.0000,"gross_charge":194.0000,"discounted_cash":194.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":255.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":200.4000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":171.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":173.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":171.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":246.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":162.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":285.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":158.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":107.2100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":153.3800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":126.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":203.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":171.2500,"methodology":"fee schedule"}]}]},{"description":"MRI of Pelvis Without Contrast","code_information":[ { "code": "72195", "type": "CPT" } ],"standard_charges":[{"minimum":139.2600,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":552.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":229.2400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":229.3800,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":229.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":201.0500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":139.2600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":201.0500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":264.0400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":146.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":201.0500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":229.3800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Hydroxyprogestone 17-D Level","code_information":[ { "code": "83498", "type": "CPT" } ],"standard_charges":[{"minimum":37.9500,"maximum":100.0000,"gross_charge":246.0000,"discounted_cash":246.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":37.9500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":97.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":54.7000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":49.4600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":37.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":97.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":38.9100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":38.9100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Hemoglobin A1c Level","code_information":[ { "code": "83036", "type": "CPT" } ],"standard_charges":[{"minimum":13.5600,"maximum":30.0000,"gross_charge":50.0000,"discounted_cash":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.5600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":28.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.6000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":13.9000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.9000,"methodology":"fee schedule"}]}]},{"description":"MRI of Pelvis With Contrast","code_information":[ { "code": "72196", "type": "CPT" } ],"standard_charges":[{"minimum":162.0900,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":386.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":295.2500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":268.5900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":300.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":268.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":233.3400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":329.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":162.0900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":233.3400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":280.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":185.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":267.5200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":268.5900,"methodology":"fee schedule"}]}]},{"description":"MRI of Pelvis With and Without Contrast","code_information":[ { "code": "72197", "type": "CPT" } ],"standard_charges":[{"minimum":197.0700,"maximum":1300.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":552.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":361.9400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":323.4900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":358.4400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":323.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":487.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":575.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":294.3100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":387.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":197.0700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":294.3100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":306.6900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":229.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":324.0800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":323.4900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - LH Hormone Level","code_information":[ { "code": "83002", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":40.0000,"gross_charge":74.0000,"discounted_cash":74.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.8800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":35.7300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":33.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":27.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - FSH Hormone Level","code_information":[ { "code": "83001", "type": "CPT" } ],"standard_charges":[{"minimum":25.3100,"maximum":60.0000,"gross_charge":83.0000,"discounted_cash":83.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":25.9700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":26.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":56.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":26.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":26.6200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":25.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":26.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":26.6200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":27.7200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":25.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.3100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":26.6200,"methodology":"fee schedule"}]}]},{"description":"MRI of Blood Vessels of Pelvis","code_information":[ { "code": "72198", "type": "CPT" } ],"standard_charges":[{"minimum":160.7400,"maximum":650.0000,"gross_charge":552.0000,"discounted_cash":552.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":312.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":310.6400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":160.7400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":310.6400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":287.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":325.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":310.6400,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Sacroiliac Joints, 1-2 Views","code_information":[ { "code": "72200", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":27.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.8500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.0300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.1300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.1700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.8500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Sacroiliac Joints, 3 or More Views","code_information":[ { "code": "72202", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":32.0000,"gross_charge":112.0000,"discounted_cash":112.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":22.2800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":25.7600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.8500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Glucose Level in Blood","code_information":[ { "code": "82947", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":8.0000,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":5.4800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":5.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":5.5600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":5.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":6.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":5.6200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":5.6200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Tailbone","code_information":[ { "code": "72220", "type": "CPT" } ],"standard_charges":[{"minimum":6.3000,"maximum":25.5000,"gross_charge":89.0000,"discounted_cash":89.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.3000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.1600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":12.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.3900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Collarbone","code_information":[ { "code": "73000", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":27.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.9400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.6200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Shoulder Blade","code_information":[ { "code": "73010", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":24.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.3200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":11.9500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.3500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.2200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Ferritin Level","code_information":[ { "code": "82728", "type": "CPT" } ],"standard_charges":[{"minimum":17.0000,"maximum":40.3000,"gross_charge":53.0000,"discounted_cash":53.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.0300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":18.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.5100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":40.3000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.5100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.0400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.5100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.5100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":23.7600,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":18.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.5700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.5100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Estrone Hormone Level","code_information":[ { "code": "82679", "type": "CPT" } ],"standard_charges":[{"minimum":34.8800,"maximum":112.7400,"gross_charge":270.0000,"discounted_cash":270.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":34.8800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":112.7400,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":64.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":43.3800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":34.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":112.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":35.7500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":35.7500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Estriol Hormone Level","code_information":[ { "code": "82677", "type": "CPT" } ],"standard_charges":[{"minimum":30.0000,"maximum":65.0000,"gross_charge":253.0000,"discounted_cash":253.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":33.7900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":39.6500,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":53.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":39.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":37.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":33.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":39.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":34.6400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":34.6400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Estrogen Hormone Level","code_information":[ { "code": "82672", "type": "CPT" } ],"standard_charges":[{"minimum":23.0000,"maximum":70.0000,"gross_charge":71.0000,"discounted_cash":71.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":30.3000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":68.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":38.0400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":30.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":31.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":31.0700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Estradiol Hormone Level","code_information":[ { "code": "82670", "type": "CPT" } ],"standard_charges":[{"minimum":38.0600,"maximum":76.0000,"gross_charge":243.0000,"discounted_cash":243.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":39.0400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":40.0200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":74.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":40.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":55.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":40.0200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":39.0400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":40.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":40.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":57.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":45.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":39.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":38.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":40.0200,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Shoulder, 1 View","code_information":[ { "code": "73020", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":25.0000,"gross_charge":56.0000,"discounted_cash":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":11.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":11.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":7.4000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":11.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":14.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.0300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.9900,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":11.3900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin D Level","code_information":[ { "code": "82652", "type": "CPT" } ],"standard_charges":[{"minimum":52.4400,"maximum":195.0000,"gross_charge":196.0000,"discounted_cash":196.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":53.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":191.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":55.1400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":157.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":55.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":195.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":55.1400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":148.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":195.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":195.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":53.7900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":55.1400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":55.1400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":88.5700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":53.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":191.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":52.4400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":55.1400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin B-12 Level","code_information":[ { "code": "82607", "type": "CPT" } ],"standard_charges":[{"minimum":18.6100,"maximum":45.5000,"gross_charge":66.0000,"discounted_cash":66.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":21.0600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":21.5900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":21.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.5900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":21.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":21.5900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.5900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.8000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":21.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.6100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":21.5900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Calculation of Creatinine Clearance","code_information":[ { "code": "82575", "type": "CPT" } ],"standard_charges":[{"minimum":8.0000,"maximum":23.1300,"gross_charge":66.0000,"discounted_cash":66.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.2000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.5300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.5300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.5300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":11.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":12.8800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.5300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Creatinine Level in Sample Other Than Blood","code_information":[ { "code": "82570", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":12.1000,"gross_charge":33.0000,"discounted_cash":33.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.0500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.4100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Shoulder, 2 or More Views","code_information":[ { "code": "73030", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":29.0000,"gross_charge":101.0000,"discounted_cash":101.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.8500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":18.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.3300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.2700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.8500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Upper Arm","code_information":[ { "code": "73060", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":29.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.5200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.1300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":21.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.3900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Cortisol Hormone Level","code_information":[ { "code": "82533", "type": "CPT" } ],"standard_charges":[{"minimum":22.7800,"maximum":45.0000,"gross_charge":83.0000,"discounted_cash":83.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":40.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":26.6800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.3500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":23.3500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Elbow , 2 Views","code_information":[ { "code": "73070", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":26.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":14.3900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":14.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":16.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.5300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.7300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.5700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":14.6200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Cholesterol Level","code_information":[ { "code": "82465", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":10.0000,"gross_charge":30.0000,"discounted_cash":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":6.0800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.1200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":6.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":6.2400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":6.2400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Calcium Level in Urine","code_information":[ { "code": "82340", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":15.0000,"gross_charge":27.0000,"discounted_cash":27.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.4300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":8.6400,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":14.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":8.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":8.6400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":8.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":8.6400,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":8.6400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.5700,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.4400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":8.6400,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Ionized Calcium Level","code_information":[ { "code": "82330", "type": "CPT" } ],"standard_charges":[{"minimum":10.0200,"maximum":52.0000,"gross_charge":140.0000,"discounted_cash":140.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":38.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":43.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":19.5100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":38.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":10.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":10.0200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Calcium Level in Blood","code_information":[ { "code": "82310", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":23.1000,"gross_charge":27.0000,"discounted_cash":27.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":23.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":6.9500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.3900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.3900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin D-3 Level","code_information":[ { "code": "82306", "type": "CPT" } ],"standard_charges":[{"minimum":36.5500,"maximum":150.0000,"gross_charge":130.0000,"discounted_cash":130.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":41.3600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":97.3500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":115.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":42.4000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":120.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":41.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":42.4000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":42.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":48.7000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":41.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":36.5500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":150.0000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of Hidden Blood in Stool Using Immunoassay","code_information":[ { "code": "82274", "type": "CPT" } ],"standard_charges":[{"minimum":9.0000,"maximum":25.0000,"gross_charge":46.0000,"discounted_cash":46.0000,"setting":"outpatient","payers_information":[{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":22.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":22.7800,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":22.7800,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Identification of Hidden Blood in Stool Sample Using Chemical Reagent for Colon Cancer Screening","code_information":[ { "code": "82270", "type": "CPT" } ],"standard_charges":[{"minimum":3.0000,"maximum":24.0000,"gross_charge":25.0000,"discounted_cash":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":4.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":4.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":4.8300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":4.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":4.4300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":4.6600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Direct Bilirubin Level","code_information":[ { "code": "82248", "type": "CPT" } ],"standard_charges":[{"minimum":7.0200,"maximum":10.1800,"gross_charge":53.0000,"discounted_cash":53.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.0200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.1800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.1000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.1900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Bilirubin Level","code_information":[ { "code": "82247", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":24.0000,"gross_charge":33.0000,"discounted_cash":33.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":7.0200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":9.2500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":7.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":9.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":7.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":7.1900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Bile Acids Level","code_information":[ { "code": "82239", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":60.0000,"gross_charge":130.0000,"discounted_cash":130.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":23.9400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":32.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.8800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":23.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.2500,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":20.2500,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Vitamin C Level","code_information":[ { "code": "82180", "type": "CPT" } ],"standard_charges":[{"minimum":13.0000,"maximum":100.0000,"gross_charge":66.0000,"discounted_cash":66.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.8100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":50.9900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":24.6000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":50.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":13.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.1900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Elbow, 3 or More Views","code_information":[ { "code": "73080", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":32.0000,"gross_charge":101.0000,"discounted_cash":101.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.4600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":14.9000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":12.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.1900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.6200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Androstenedione Hormone Levels","code_information":[ { "code": "82157", "type": "CPT" } ],"standard_charges":[{"minimum":40.9000,"maximum":125.0000,"gross_charge":300.0000,"discounted_cash":300.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":40.9000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":122.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":66.9300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":68.7800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":40.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":122.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":41.9300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":41.9300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Lower Arm","code_information":[ { "code": "73090", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":27.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":27.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":10.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":12.6200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":11.6400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":15.5700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.9300,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Baby's Arm","code_information":[ { "code": "73092", "type": "CPT" } ],"standard_charges":[{"minimum":10.4300,"maximum":26.0000,"gross_charge":46.0000,"discounted_cash":46.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.5000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.9300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.1500,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":10.6400,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":14.2300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.1600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":14.2300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.4500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":14.2300,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.1500,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Wrist, 2 Views","code_information":[ { "code": "73100", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":26.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":15.7800,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.2300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":23.9500,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":14.5700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":23.9500,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.3200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.2400,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.2300,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Pituitary Hormone Level","code_information":[ { "code": "82024", "type": "CPT" } ],"standard_charges":[{"minimum":52.0000,"maximum":140.0000,"gross_charge":333.0000,"discounted_cash":333.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":53.9700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":87.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":96.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":96.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":96.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":60.2100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":53.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":98.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":55.3200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":55.3200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Urine Pregnancy Test","code_information":[ { "code": "81025", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":13.0000,"gross_charge":20.0000,"discounted_cash":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.1300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":8.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":9.0600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":9.0600,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Wrist, 3 or More Views","code_information":[ { "code": "73110", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":32.0000,"gross_charge":78.0000,"discounted_cash":78.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.9300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":20.6100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":20.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":28.3000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.3200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":28.3000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":15.6500,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":13.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":28.3000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":20.6100,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Hand, 2 Views","code_information":[ { "code": "73120", "type": "CPT" } ],"standard_charges":[{"minimum":7.3500,"maximum":26.0000,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":7.3500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":13.7000,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":11.1000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":13.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":11.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":9.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":24.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":13.2500,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":13.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":10.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":20.2900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":13.6900,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Hand, 3 or More Views","code_information":[ { "code": "73130", "type": "CPT" } ],"standard_charges":[{"minimum":8.7500,"maximum":32.0000,"gross_charge":46.0000,"discounted_cash":46.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.4700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.9200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":13.8800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":13.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":15.5000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":12.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":25.0300,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.2100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":25.0300,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":13.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":12.4800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":23.5600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.9200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Topiramate Level","code_information":[ { "code": "80201", "type": "CPT" } ],"standard_charges":[{"minimum":8.5400,"maximum":125.0000,"gross_charge":175.0000,"discounted_cash":175.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":125.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":80.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":17.0700,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":17.0700,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Tacrolimus Level","code_information":[ { "code": "80197", "type": "CPT" } ],"standard_charges":[{"minimum":9.8300,"maximum":170.0000,"gross_charge":190.0000,"discounted_cash":190.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.1700,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":19.1700,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":170.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":9.8300,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":19.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.6600,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.6600,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Free Phenytoin Level","code_information":[ { "code": "80186", "type": "CPT" } ],"standard_charges":[{"minimum":16.8000,"maximum":65.0000,"gross_charge":91.0000,"discounted_cash":91.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":44.0000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":65.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.9000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":19.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.8000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Phenytoin Level","code_information":[ { "code": "80185", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":40.0000,"gross_charge":74.0000,"discounted_cash":74.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.5200,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":38.3800,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":31.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":18.9900,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":18.9900,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Phenobarbital Level","code_information":[ { "code": "80184", "type": "CPT" } ],"standard_charges":[{"minimum":16.0100,"maximum":40.0000,"gross_charge":80.0000,"discounted_cash":80.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":16.0100,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":20.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":39.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":20.7100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":16.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":20.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.4100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.4100,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Valproic Acid Level","code_information":[ { "code": "80164", "type": "CPT" } ],"standard_charges":[{"minimum":18.9300,"maximum":50.0000,"gross_charge":86.0000,"discounted_cash":86.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.9300,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":46.1300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.2000,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.4000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.4000,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Digoxin Level","code_information":[ { "code": "80162", "type": "CPT" } ],"standard_charges":[{"minimum":18.5500,"maximum":40.8000,"gross_charge":40.0000,"discounted_cash":40.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.5500,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":40.8000,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":32.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":22.0100,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":18.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":23.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":19.0200,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.0200,"methodology":"fee schedule"}]}]},{"description":"Lab Test - Total Carbamazepine Level","code_information":[ { "code": "80156", "type": "CPT" } ],"standard_charges":[{"minimum":16.8000,"maximum":42.7500,"gross_charge":60.0000,"discounted_cash":60.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":20.3400,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":21.4900,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":42.7500,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":26.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":19.8800,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":20.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":21.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":16.8000,"methodology":"fee schedule"}]}]},{"description":"X-Ray of Fingers","code_information":[ { "code": "73140", "type": "CPT" } ],"standard_charges":[{"minimum":4.9000,"maximum":27.2100,"gross_charge":67.0000,"discounted_cash":67.0000,"setting":"outpatient","payers_information":[{"payer_name":"AARP","plan_name":"AARP Commercial","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA Commercial","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Aetna Commercial","standard_charge_dollar":18.0900,"methodology":"fee schedule"},{"payer_name":"BL","plan_name":"BL Blue Cross\/Blue Shield","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"CH","plan_name":"CH Champus","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Cigna Commercial","standard_charge_dollar":8.3300,"methodology":"fee schedule"},{"payer_name":"Comerciales","plan_name":"Comerciales Commercial","standard_charge_dollar":19.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Commercial","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Fondo Del Seguro Estado","plan_name":"Fondo Del Seguro Estado Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Hospicio","plan_name":"Hospicio Medicare Advantage","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Commercial","standard_charge_dollar":12.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Medicare Advantage","standard_charge_dollar":27.2100,"methodology":"fee schedule"},{"payer_name":"MAPFRE","plan_name":"MAPFRE Commercial","standard_charge_dollar":16.0000,"methodology":"fee schedule"},{"payer_name":"MC","plan_name":"MC Medicaid","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Commercial","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Medicare Advantage","standard_charge_dollar":15.7300,"methodology":"fee schedule"},{"payer_name":"MSO","plan_name":"MSO Medicare Advantage","standard_charge_dollar":27.2100,"methodology":"fee schedule"},{"payer_name":"Plan de Salud Menonita","plan_name":"Plan de Salud Menonita Commercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam Commercial","standard_charge_dollar":10.7200,"methodology":"fee schedule"},{"payer_name":"TRICARE","plan_name":"TRICARE Commercial","standard_charge_dollar":11.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Commercial","standard_charge_dollar":22.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Medicare Advantage","standard_charge_dollar":27.2100,"methodology":"fee schedule"},{"payer_name":"VA","plan_name":"VA Veterans Affairs Program","standard_charge_dollar":19.0000,"methodology":"fee schedule"}]}]}]}