{"hospital_name": "Hilton Head Medical Center LLC", "last_updated_on": "2026-03-12", "version": "3.0.0", "pid": "1514654475", "rid": "5128", "location_name": ["Hilton Head Hospital"], "hospital_address": ["25 Hospital Center Blvd, Hilton Head Island, SC 29926"], "type_2_npi": ["1902675101"], "license_information": {"license_number": "HTL-0973", "state": "SC"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Jason Schmiedt"}, "standard_charge_information": [{"description": "\"\"Y SET\"\" TUBING", "code_information": [{"code": "A4719", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.0, "maximum": 4.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 10.0, "maximum": 14.82, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BOD TEMP >=35.5", "code_information": [{"code": "G9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BODYTEMP >=35.5CW/IN 30MIN", "code_information": [{"code": "4559F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4206", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.37, "maximum": 0.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.3, "maximum": 27.3, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 MED VISIT IN 24MO", "code_information": [{"code": "G9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 OR NO CT SINUS W/IN 90D DX", "code_information": [{"code": "G9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "100 INSULIN SYRINGES", "code_information": [{"code": "S8490", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.41, "maximum": 25.41, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.41, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "12-LEAD ECG PERFORMED", "code_information": [{"code": "3120F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1DOSE MENIG VAC BTWN 11 & 13", "code_information": [{"code": "G9414", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 194.01, "maximum": 194.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 194.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}, {"code": "762", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.3, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.8, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 131.11, "maximum": 131.11, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 131.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}, {"code": "762", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.3, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.8, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 96.66, "maximum": 96.66, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 96.66, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}, {"code": "762", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.3, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Observation No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.8, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 160.11, "maximum": 160.11, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 160.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 124.75, "maximum": 124.75, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 124.75, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 86.26, "maximum": 86.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.26, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 220.88, "maximum": 220.88, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 220.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 94.49, "maximum": 211.66, "discounted_cash": 107.45, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 107.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 97.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 98.27, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 98.27, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 165.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 99.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 211.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 99.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 41.63, "maximum": 41.63, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4207", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.15, "maximum": 0.15, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.15, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.75, "maximum": 15.75, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.1, "maximum": 65.1, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.1, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.75, "maximum": 15.75, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.1, "maximum": 65.1, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.1, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.55, "maximum": 53.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.55, "maximum": 53.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.55, "maximum": 53.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.55, "maximum": 53.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2+ ANTI-HYPRTNSV AGENTS TKN", "code_information": [{"code": "4145F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTIPSY SCHIZ", "code_information": [{"code": "G0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ BENZO SEIZ", "code_information": [{"code": "G0033", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "20+ CC SYRINGE ONLY", "code_information": [{"code": "A4213", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.74, "maximum": 0.74, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.02, "maximum": 80.46, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 59.27, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 29.42, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 37.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 36.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 62.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 37.72, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.72, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D CEPHAL RADIO IMAGE", "code_information": [{"code": "D0702", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.94, "maximum": 181.31, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 133.55, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 83.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 84.18, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 84.18, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 82.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 141.65, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 82.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 84.99, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 181.31, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 84.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D CEPHALOMETRIC IMAGE", "code_information": [{"code": "D0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.94, "maximum": 181.31, "discounted_cash": 124.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 133.55, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 124.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 83.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 84.18, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 84.18, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 82.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 141.65, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 82.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 84.99, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 181.31, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 84.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D ORAL/FACIAL PHOTO IMAGE", "code_information": [{"code": "D0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.94, "maximum": 181.31, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 133.55, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 83.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 84.18, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 84.18, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 82.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 141.65, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 82.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 84.99, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 181.31, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 84.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 729.11, "maximum": 2896.77, "discounted_cash": 1824.41, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1203.03, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 2896.77, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 2896.77, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1824.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 750.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 758.27, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 758.27, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 743.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1275.94, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 743.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 765.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1633.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 765.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 259.0, "maximum": 674.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 535.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 674.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 729.11, "maximum": 2896.77, "discounted_cash": 1824.41, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1203.03, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 2896.77, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 2896.77, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1824.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 750.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 758.27, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 758.27, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 743.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1275.94, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 743.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 765.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1633.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 765.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 259.0, "maximum": 674.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 535.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 674.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 324.48, "maximum": 2896.77, "discounted_cash": 664.42, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 535.39, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 2896.77, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1598.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 2896.77, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 664.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 334.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 337.46, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 337.46, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 330.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 567.84, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 330.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 340.7, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 726.84, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 340.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 324.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 259.0, "maximum": 674.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 535.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 674.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 141.25, "maximum": 141.25, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 141.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4208", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.37, "maximum": 0.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 COMP FOOT EXAM COMPLETED", "code_information": [{"code": "G9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 1085.11, "maximum": 4568.56, "discounted_cash": 2563.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2124.13, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1139.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 2520.97, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 4568.56, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 2520.97, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 4568.56, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 2563.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1325.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1338.84, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1338.84, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1085.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1313.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2252.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1085.11, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1313.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1351.72, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 2883.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1085.11, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1351.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1287.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN DIRECT", "code_information": [{"code": "D0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.58, "maximum": 23.58, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN INDIRECT", "code_information": [{"code": "D0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.58, "maximum": 23.58, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 24.85, "maximum": 50.74, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 259.0, "maximum": 674.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 535.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 674.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN DIRECT", "code_information": [{"code": "D0803", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.06, "maximum": 19.06, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN INDIRECT", "code_information": [{"code": "D0804", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.06, "maximum": 19.06, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D PRINT OF 3D SURFACE SCAN", "code_information": [{"code": "D0396", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 210.4, "maximum": 275.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 220.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76377", "type": "CPT"}], "standard_charges": [{"minimum": 216.55, "maximum": 275.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 216.55, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 216.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 216.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"minimum": 38.79, "maximum": 38.79, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}], "standard_charges": [{"minimum": 221.92, "maximum": 497.1, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 366.17, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 228.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 230.8, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 230.8, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 226.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 388.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 226.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 233.02, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 497.1, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 233.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 241.72, "maximum": 241.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}, {"code": "321", "type": "RC"}], "standard_charges": [{"minimum": 241.72, "maximum": 241.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 241.72, "maximum": 241.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}, {"code": "323", "type": "RC"}], "standard_charges": [{"minimum": 241.72, "maximum": 241.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 241.72, "maximum": 241.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", 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"additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}, {"code": "409", "type": "RC"}], "standard_charges": [{"minimum": 241.72, "maximum": 241.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 241.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy", "code_information": [{"code": "G0566", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.68, "maximum": 293.36, "discounted_cash": 293.36, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 197.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 293.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 125.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 268.08, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D-CRT/IMRT RECEIVED", "code_information": [{"code": "4165F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy", "code_information": [{"code": "C8001", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.68, "maximum": 268.08, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 197.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 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"methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.07, 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"payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed 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payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 163.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE WITH POTASSIUM", "code_information": [{"code": "S5012", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.67, "maximum": 4.67, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% WL MAINTND FROM BSLINE WT", "code_information": [{"code": "G9888", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5%DEXTROSE/0.45%SALINE1000ML", "code_information": [{"code": "S5013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5+ CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4209", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.37, "maximum": 0.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO EVC RTNOPTHY", "code_information": [{"code": "2024F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO W/O RTNOPTHY", "code_information": [{"code": "2025F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.65, "maximum": 97.65, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 97.65, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 406.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"minimum": 125.47, "maximum": 293.16, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 293.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 125.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 125.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<50% TOTAL PT OUTPT RA ENCTS", "code_information": [{"code": "M1008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<6YR NEW ONSET HD ACHE", "code_information": [{"code": "G2193", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">55 YRS TEMP HD ACHE", "code_information": [{"code": "G2192", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED NOT ORD", "code_information": [{"code": "G9368", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED ORD", "code_information": [{"code": "G9367", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME HI-RSK MED W/O DIAG", "code_information": [{"code": "M1209", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME MEDS TBL4 NOT ORD", "code_information": [{"code": "M1210", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=50% TOTAL PT OUTPT RA ENCT", "code_information": [{"code": "M1007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=86Y NO HX COLO CA/RSN SCOP", "code_information": [{"code": "G9659", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified", "code_information": [{"code": "M1379", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D HALFWAY HOUSE, PER DIEM", "code_information": [{"code": "H2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.52, "maximum": 18.52, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER DIEM", "code_information": [{"code": "H2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 321.95, "maximum": 321.95, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 321.95, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER HOUR", "code_information": [{"code": "H2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.93, "maximum": 59.93, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 59.93, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AAC NON-ELECTRONIC BOARD", "code_information": [{"code": "E1902", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.32, "maximum": 138.32, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.16, "maximum": 89.96, "discounted_cash": 43.44, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 43.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 40.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 70.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 89.96, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 43.8, "maximum": 43.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 43.8, "maximum": 43.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 43.8, "maximum": 43.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 43.8, "maximum": 43.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 43.8, "maximum": 43.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABCIXIMAB PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1326.61, "maximum": 10617.3, "gross_charge": 11797.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1392.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 5898.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 6936.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 5898.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4246.92, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 6936.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 6936.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 5898.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1993.69, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 3609.88, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1993.69, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 3609.88, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 3798.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4010.98, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3539.1, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3539.1, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 2949.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 2949.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 6902.42, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10617.3, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 10617.3, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 7078.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABCIXIMAB PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1326.61, "maximum": 10617.3, "gross_charge": 11797.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1392.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 5898.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 6936.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 5898.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4246.92, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 6936.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 6936.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 5898.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1993.69, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 3609.88, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1993.69, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 3609.88, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 3798.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 4010.98, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3539.1, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3539.1, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 2949.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 2949.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 6902.42, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10617.3, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 10617.3, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 7078.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1326.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD IMAG W/US, CT OR MRI", "code_information": [{"code": "G9455", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"minimum": 843.57, "maximum": 1889.6, "discounted_cash": 1017.59, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1391.89, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1406.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 994.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 994.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1017.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 868.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 877.31, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 877.31, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 860.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1476.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 860.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 885.75, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1889.6, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 885.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.57, "maximum": 12538.0, "gross_charge": 6155.0, "discounted_cash": 1017.59, "estimated_discounted_cash": 9085.18, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1391.89, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1406.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 3077.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 3619.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 3077.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2215.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 3619.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 3619.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 3077.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 994.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 994.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1017.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1981.91, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 868.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2092.7, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 877.31, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 877.31, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 3601.29, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 860.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1476.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 860.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5539.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 5539.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 3693.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 885.75, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1889.6, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 885.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}, {"minimum": 843.57, "maximum": 12538.0, "gross_charge": 9962.0, "discounted_cash": 1017.59, "estimated_discounted_cash": 9085.18, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1391.89, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1406.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 4981.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 5857.65, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 4981.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3586.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 5857.65, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 5857.65, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 4981.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 994.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 994.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1017.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 3207.76, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 868.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3387.08, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 877.31, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 877.31, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 5828.76, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 860.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1476.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 860.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8965.8, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 8965.8, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 5977.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 885.75, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1889.6, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 885.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 843.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "estimated_discounted_cash": 9085.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 300.0, "maximum": 672.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 309.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 300.0, "maximum": 300.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 1616.01, "maximum": 1616.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1616.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"minimum": 693.55, "maximum": 693.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 693.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 1621.77, "maximum": 1621.77, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1621.77, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"minimum": 1007.18, "maximum": 1007.18, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1007.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 2318.0, "maximum": 2318.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2318.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 1950.57, "maximum": 1950.57, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1950.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 778.84, "maximum": 778.84, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 778.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 2205.67, "maximum": 2205.67, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2205.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 822.23, "maximum": 36529.52, "discounted_cash": 9653.78, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 26907.9, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 863.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 8458.74, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 15329.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 8458.74, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 15329.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 9653.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 16797.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 16960.13, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 16960.13, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 16633.98, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 28538.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16633.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 17123.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 36529.52, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17123.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16307.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 6748.84, "maximum": 15329.12, "discounted_cash": 9653.78, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 11135.59, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 8458.74, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 15329.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 8458.74, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 15329.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 9653.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 6951.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7018.79, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7018.79, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 6883.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 11810.47, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6883.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7086.28, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 15117.4, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7086.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 1731.46, "maximum": 1731.46, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 1936.17, "maximum": 1936.17, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1936.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 1929.35, "maximum": 1929.35, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1929.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 1585.73, "maximum": 16679.85, "discounted_cash": 10504.51, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 11969.58, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1665.02, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 9204.08, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 16679.85, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 9204.08, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 16679.85, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 10504.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 7471.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7544.46, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7544.46, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1585.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 7399.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 12695.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1585.73, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7399.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7617.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 16249.61, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1585.73, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7617.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7254.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 7174.0, "maximum": 18745.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 14876.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 7174.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 18745.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 822.23, "maximum": 3232.52, "discounted_cash": 1602.87, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2381.1, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 863.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1404.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 2546.11, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1404.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 2546.11, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1602.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1486.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1500.81, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1500.81, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1471.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2525.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1471.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1515.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 3232.52, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1515.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}], "standard_charges": [{"minimum": 822.23, "maximum": 3232.52, "discounted_cash": 1602.87, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2381.1, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 863.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 1404.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 2546.11, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 1404.96, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 2546.11, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1602.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1486.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1500.81, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1500.81, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1471.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2525.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1471.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1515.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 3232.52, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1515.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 4605.18, "maximum": 22145.92, "discounted_cash": 7252.24, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 16312.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 4835.44, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 7252.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 10183.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 10282.03, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 10282.03, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 4605.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 10084.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 17301.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 4605.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10084.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 10380.9, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 22145.92, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 4605.18, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10380.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9886.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 5622.81, "maximum": 15717.09, "discounted_cash": 9897.48, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 9277.64, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 8672.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 15717.09, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 8672.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 15717.09, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 9897.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5791.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5847.72, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5847.72, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5735.27, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 9839.92, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5735.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5903.95, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 12595.09, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5903.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5622.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1536.11, "maximum": 3440.89, "discounted_cash": 2202.2, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2534.58, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1582.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1597.55, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1597.55, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1566.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2688.19, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1566.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1612.92, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 3440.89, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1612.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1536.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 3641.66, "maximum": 8157.32, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 6008.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3750.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3787.33, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3787.33, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3714.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 6372.91, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3714.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3823.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 8157.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3823.74, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3641.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"minimum": 1457.63, "maximum": 1457.63, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1457.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 700.04, "maximum": 19722.19, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 14527.51, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 735.04, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 9068.69, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 9156.73, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 9156.73, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 700.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8980.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 15407.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 700.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8980.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 9244.78, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 19722.19, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 700.04, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9244.78, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8804.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 1816.19, "maximum": 4068.27, "discounted_cash": 2514.52, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2996.71, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 2514.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1870.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1888.84, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1888.84, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1852.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 3178.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1852.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1907.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 4068.27, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1907.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 8162.22, "maximum": 18283.37, "discounted_cash": 8169.44, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 13467.66, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 8169.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8407.09, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8488.71, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8488.71, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8325.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 14283.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8325.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8570.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 18283.37, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8570.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8162.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 1816.19, "maximum": 4068.27, "discounted_cash": 2514.52, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2996.71, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 2514.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1870.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1888.84, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1888.84, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1852.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 3178.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1852.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1907.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 4068.27, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1907.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1816.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 12422.0, "maximum": 32456.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25758.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12422.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 615.62, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 453.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 283.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 285.82, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 285.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 480.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 615.62, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 615.62, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 453.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 283.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 285.82, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 285.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 480.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 615.62, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO RH BLOOD TYPING DOCD", "code_information": [{"code": "3293F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.97, "maximum": 17.85, "discounted_cash": 13.29, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 9.19, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 8.53, "maximum": 8.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 8.53, "maximum": 8.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.53, "maximum": 8.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 8.53, "maximum": 8.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 8.53, "maximum": 8.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 822.23, "maximum": 6744.15, "discounted_cash": 4210.44, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 4967.79, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 863.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 3689.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 6686.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 3689.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 6686.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 4210.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3101.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3131.21, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3131.21, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3071.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 5268.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3071.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3161.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 6744.15, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3161.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 1585.73, "maximum": 6744.15, "discounted_cash": 4210.44, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 4967.79, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1665.02, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 3689.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 6686.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 3689.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 6686.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 4210.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3101.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3131.21, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3131.21, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1585.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3071.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 5268.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1585.73, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3071.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3161.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 6744.15, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1585.73, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3161.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3010.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 435.25, "maximum": 435.25, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 435.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 467.78, "maximum": 467.78, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 467.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 640.59, "maximum": 640.59, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.59, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 491.82, "maximum": 491.82, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 491.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 577.83, "maximum": 577.83, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 577.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 4799.0, "maximum": 12538.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 9951.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 4799.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 12538.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 644.89, "maximum": 644.89, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 644.89, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 283.42, "maximum": 1014.37, "discounted_cash": 572.83, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 467.64, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 559.74, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1014.37, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 559.74, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1014.37, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 572.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 291.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 294.76, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 294.76, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 495.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 289.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 297.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 634.86, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8946.38, "maximum": 51672.14, "discounted_cash": 9447.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 15656.17, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 10334.64, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 18814.36, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 10334.64, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 18814.36, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 9447.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 9214.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 9304.24, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 9304.24, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 9125.31, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 15656.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9125.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 9393.7, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 20039.89, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9393.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 41008.42, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 20096.11, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8946.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 51672.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5012.0, "maximum": 43354.71, "discounted_cash": 5012.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 13136.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 6919.84, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 12597.68, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 6919.84, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 12597.68, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 5012.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 7731.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7806.57, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7806.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 7656.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 13136.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7656.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7881.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 16814.16, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7881.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 34407.49, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 16861.33, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7506.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 43354.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABOVE KNEE SURGICAL STOCKING", "code_information": [{"code": "A4490", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.79, "maximum": 4.79, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.79, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 154.45, "maximum": 418.01, "discounted_cash": 176.13, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 307.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 154.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 279.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 154.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 279.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 176.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 192.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 194.07, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 194.07, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 326.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 195.94, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 418.01, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 195.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 19.8, "maximum": 279.89, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.8, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 154.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 279.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 154.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 279.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}], "standard_charges": [{"minimum": 164.59, "maximum": 275.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 172.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG <= 16 SUC PUMP", "code_information": [{"code": "K0744", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.53, "maximum": 19.53, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >16<=48 SUC PUMP", "code_information": [{"code": "K0745", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >48 SUC PUMP", "code_information": [{"code": "K0746", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORPT DRG > 48 SQ IN W/BDR", "code_information": [{"code": "A6256", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.0, "maximum": 4.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT CROWN PORC TO TITANIUM", "code_information": [{"code": "D6097", "type": "HCPCS"}], "standard_charges": [{"minimum": 327.93, "maximum": 327.93, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 327.93, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6195", "type": "HCPCS"}], "standard_charges": [{"minimum": 384.94, "maximum": 384.94, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 384.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT CROWN TITANIUM", "code_information": [{"code": "D6094", "type": "HCPCS"}], "standard_charges": [{"minimum": 422.84, "maximum": 422.84, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 422.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT RETAINER TITANI", "code_information": [{"code": "D6194", "type": "HCPCS"}], "standard_charges": [{"minimum": 435.46, "maximum": 435.46, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 435.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED CROWN", "code_information": [{"code": "D6058", "type": "HCPCS"}], "standard_charges": [{"minimum": 540.05, "maximum": 540.05, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 540.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6059", "type": "HCPCS"}], "standard_charges": [{"minimum": 532.74, "maximum": 532.74, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 532.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6060", "type": "HCPCS"}], "standard_charges": [{"minimum": 503.86, "maximum": 503.86, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 503.86, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6061", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.92, "maximum": 513.92, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 513.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6062", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.89, "maximum": 511.89, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 511.89, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6063", "type": "HCPCS"}], "standard_charges": [{"minimum": 445.87, "maximum": 445.87, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 445.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6064", "type": "HCPCS"}], "standard_charges": [{"minimum": 466.35, "maximum": 466.35, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 466.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6068", "type": "HCPCS"}], "standard_charges": [{"minimum": 535.5, "maximum": 535.5, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6069", "type": "HCPCS"}], "standard_charges": [{"minimum": 532.74, "maximum": 532.74, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 532.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6070", "type": "HCPCS"}], "standard_charges": [{"minimum": 503.86, "maximum": 503.86, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 503.86, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6071", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.92, "maximum": 513.92, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 513.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6072", "type": "HCPCS"}], "standard_charges": [{"minimum": 519.78, "maximum": 519.78, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 519.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6073", "type": "HCPCS"}], "standard_charges": [{"minimum": 474.97, "maximum": 474.97, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 474.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6074", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.58, "maximum": 504.58, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 504.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABX PRES W/IN 10 DYS OF SYMP", "code_information": [{"code": "G9505", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABX REG PRESCRIBED", "code_information": [{"code": "G9498", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AC5 WOUND SYSTEM", "code_information": [{"code": "A2020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACAPatch, per square centimeter", "code_information": [{"code": "Q4325", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS OF TRANSEP CYTOL SAMP", "code_information": [{"code": "D0486", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.01, "maximum": 49.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 349.38, "maximum": 349.38, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 349.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 2945.0, "maximum": 7695.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6107.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 2945.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7695.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACE ARB ARNI", "code_information": [{"code": "G2092", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE-I/ARB RX", "code_information": [{"code": "M1200", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB NOT RX'D; DOC REAS", "code_information": [{"code": "G8474", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THERAPY RXD/TAKEN", "code_information": [{"code": "4010F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY FOR MOS/>", "code_information": [{"code": "4210F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY NOT RX'D", "code_information": [{"code": "G8475", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY RX'D", "code_information": [{"code": "G8473", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACEBUTOLOL 200MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.02, "gross_charge": 0.03, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.02, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 0.02, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 0.01, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 0.25, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 0.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 0.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", 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"standard_charge_dollar": 1185.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 1935.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1646.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 1935.69, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 1646.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1646.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1060.02, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1119.28, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 987.6, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 987.6, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 823.0, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 823.0, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 834.19, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 1926.14, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 834.19, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2962.8, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 2962.8, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 1975.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 834.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}], "standard_charges": [{"minimum": 240.03, "maximum": 5399.46, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1406.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 2979.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 5399.46, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 2979.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 5399.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACESSO DL, PER SQ CM", "code_information": [{"code": "Q4293", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACESSO TL, PER SQ CM", "code_information": [{"code": "Q4300", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETATE CONC SOL PER GALLON", "code_information": [{"code": "A4708", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.0, "maximum": 6.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMI UPTO 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 19.84, "maximum": 391.5, "gross_charge": 435.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 217.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 255.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 217.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 156.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 255.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 255.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 217.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 140.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 147.9, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 130.5, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 130.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 108.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 108.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 254.51, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 391.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 391.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMI UPTO 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 19.84, "maximum": 391.5, "gross_charge": 435.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 217.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 255.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 217.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 156.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 255.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 255.78, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 217.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 140.07, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 147.9, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 130.5, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 130.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 108.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 108.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 254.51, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 391.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 391.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}], "standard_charges": [{"minimum": 8.17, "maximum": 49.94, "discounted_cash": 35.59, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 49.94, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 49.94, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 35.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 8.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 8.62, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 8.62, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee 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"maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee 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"maximum": 8.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 12.29, "maximum": 64.89, "discounted_cash": 64.89, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 64.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12.78, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12.54, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 21.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.29, "maximum": 12.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", 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"maximum": 12.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 12.29, "maximum": 12.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 12.29, "maximum": 12.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 12.29, "maximum": 12.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 41.22, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 41.22, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 41.22, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 41.22, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 26.99, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12.53, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12.53, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", 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"payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEIN PER100MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.74, "maximum": 20.7, "gross_charge": 23.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 6.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 11.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 13.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 11.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 8.28, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 13.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 13.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 11.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 3.88, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 7.03, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 3.88, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 7.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 7.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7.82, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 6.9, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 6.9, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 13.45, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.7, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 20.7, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 13.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEIN PER100MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.74, "maximum": 20.7, "gross_charge": 23.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 6.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 11.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 13.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 11.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 8.28, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 13.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 13.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 11.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 3.88, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 7.03, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 3.88, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 7.03, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 7.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 7.82, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 6.9, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 6.9, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 13.45, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.7, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 20.7, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 13.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7604", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.17, "maximum": 9.43, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 9.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 8.98, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 8.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 8.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACID CONC SOL PER GALLON", "code_information": [{"code": "A4709", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.0, "maximum": 5.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 347.07, "maximum": 1342.94, "discounted_cash": 845.19, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 572.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 741.05, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1342.94, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 741.05, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1342.94, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 845.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 357.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 360.95, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 360.95, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 354.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 607.37, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 354.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 777.44, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 347.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 154.45, "maximum": 863.34, "discounted_cash": 176.13, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 307.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 863.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 154.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 279.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 154.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 279.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 176.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 192.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 194.07, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 194.07, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 326.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 195.94, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 418.01, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 822.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 195.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 186.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}], "standard_charges": [{"minimum": 99.69, "maximum": 268.08, "discounted_cash": 99.69, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 197.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 99.69, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 125.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 268.08, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}, {"code": "470", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}, {"code": "472", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}, {"code": "479", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"minimum": 34.74, "maximum": 159.86, "discounted_cash": 100.8, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 57.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 88.21, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 88.21, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 35.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 36.13, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 36.13, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 35.43, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 77.82, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}, {"code": "470", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}, {"code": "472", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}, {"code": "479", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS-NO DSCNMKR DOCD", "code_information": [{"code": "1124F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS/DSCN MKR DOCD", "code_information": [{"code": "1123F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 32.62, "maximum": 85.27, "discounted_cash": 85.27, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 53.82, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 85.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 33.92, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 33.92, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 42.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 33.27, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 57.09, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 42.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 73.07, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 42.03, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 32.62, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 86.96, "maximum": 228.85, "discounted_cash": 228.85, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 143.48, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 117.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 228.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 89.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 90.44, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 90.44, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 112.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 88.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 152.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 112.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 88.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 91.31, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 194.79, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 112.07, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 91.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 86.96, "maximum": 86.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 78.26, "maximum": 205.52, "discounted_cash": 205.52, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 129.13, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 105.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 205.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 80.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 81.39, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 81.39, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 100.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 79.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 136.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 100.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 79.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 175.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 100.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 78.26, "maximum": 78.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"minimum": 54.87, "maximum": 400.64, "discounted_cash": 252.56, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 90.54, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 81.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 221.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 400.64, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 221.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 400.64, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 252.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 56.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 77.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 55.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 96.02, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 77.94, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 57.61, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 122.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 77.94, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 26.99, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12.53, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12.53, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "estimated_discounted_cash": 183.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIVATE MATRIX, PER SQ CM", "code_information": [{"code": "Q4301", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIVATED CARBON FILTER, EA", "code_information": [{"code": "A4680", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.59, "maximum": 48.59, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.59, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVITY THERAPY, PER 15 MIN", "code_information": [{"code": "H2032", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.69, "maximum": 1.69, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1.69, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL 15 MIN", "code_information": [{"code": "97810", "type": "CPT"}], "standard_charges": [{"minimum": 26.9, "maximum": 60.26, "discounted_cash": 35.45, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 44.39, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 35.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 27.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 27.98, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 27.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 60.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 25.61, "maximum": 25.61, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL 15 MIN", "code_information": [{"code": "97813", "type": "CPT"}], "standard_charges": [{"minimum": 26.9, "maximum": 60.26, "discounted_cash": 35.45, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 44.39, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 35.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 27.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 27.98, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 27.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 60.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL ADDL 15M", "code_information": [{"code": "97814", "type": "CPT"}], "standard_charges": [{"minimum": 28.14, "maximum": 28.14, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8567.18, "maximum": 49481.99, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 14992.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8824.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8909.87, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8909.87, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8738.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 14992.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8738.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8995.54, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 19190.48, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8995.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 39270.26, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 19244.33, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8567.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 49481.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [{"code": "289", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15229.46, "maximum": 87961.68, "discounted_cash": 28597.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 26651.56, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 32869.86, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 59840.07, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 32869.86, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 59840.07, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 28597.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 15686.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 15838.64, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 15838.64, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 15534.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 26651.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15534.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 15990.93, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 34113.99, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15990.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 69808.8, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 34209.69, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15229.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 87961.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [{"code": "288", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17047.0, "maximum": 139458.6, "discounted_cash": 17047.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 42254.63, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 44840.36, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 81632.52, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 44840.36, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 81632.52, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 17047.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 24869.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 25111.32, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 25111.32, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 24628.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 42254.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24628.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 25352.78, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 54085.92, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25352.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 110678.17, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 54237.66, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24145.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 139458.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [{"code": "290", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8295.05, "maximum": 47910.23, "discounted_cash": 15576.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 14516.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 18500.07, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 33679.65, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 18500.07, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 33679.65, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 15576.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8543.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8626.85, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8626.85, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8460.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 14516.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8460.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8709.8, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 18580.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8709.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 38022.87, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 18633.05, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8295.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 47910.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CHRONIC OBSTRUCT", "code_information": [{"code": "G9681", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CONGESTIVE HEART", "code_information": [{"code": "G9680", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE PNEUMONIA", "code_information": [{"code": "G9679", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE SKIN INFECTION", "code_information": [{"code": "G9682", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE URINARY TRACT INF", "code_information": [{"code": "G9684", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE FLUID/ELECTRO DISORDER", "code_information": [{"code": "G9683", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}], "standard_charges": [{"minimum": 254.68, "maximum": 1243.94, "discounted_cash": 318.4, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 267.41, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 686.42, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1243.94, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 686.42, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1243.94, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 318.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 382.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 386.69, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 386.69, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 379.26, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 650.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 390.41, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 832.88, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 390.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}, {"code": "340", "type": "RC"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}, {"code": "349", "type": "RC"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}], "standard_charges": [{"minimum": 47.63, "maximum": 352.62, "discounted_cash": 151.94, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 59.96, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 194.58, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 352.62, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 194.58, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 352.62, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 151.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 49.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 57.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 48.58, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 83.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 57.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 50.01, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 106.69, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 57.1, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 47.63, "maximum": 47.63, "estimated_discounted_cash": 80.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18610.11, "maximum": 167541.24, "discounted_cash": 32940.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 32567.69, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 92029.6, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 167541.24, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 92029.6, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 167541.24, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 32940.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 19168.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 19354.51, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 19354.51, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 18982.31, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 32567.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18982.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 19540.62, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 41686.65, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19540.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 85305.05, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 41803.6, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18610.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 107487.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48982.48, "maximum": 345375.55, "discounted_cash": 70570.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 85719.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 189713.13, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 345375.55, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 189713.13, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 345375.55, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 70570.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 50451.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 50941.78, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 50941.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 49962.13, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 85719.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49962.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 51431.6, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 109720.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51431.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 224525.93, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 110028.58, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48982.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 282911.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES", "code_information": [{"code": "850", "type": "MS-DRG"}], "standard_charges": [{"minimum": 77262.57, "maximum": 446250.01, "discounted_cash": 98289.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 135209.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 140871.78, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 256459.14, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 140871.78, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 256459.14, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 98289.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 79580.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 80353.07, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 80353.07, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 78807.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 135209.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78807.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 81125.7, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 173068.16, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 81125.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 354156.23, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 173553.7, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 77262.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 446250.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "836", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10880.73, "maximum": 62844.49, "discounted_cash": 14519.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 19041.28, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 34363.43, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 62559.13, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 34363.43, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 62559.13, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 14519.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 11207.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 11315.96, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 11315.96, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 11098.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 19041.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11098.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 11424.77, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 24372.84, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11424.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 49875.11, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 24441.22, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10880.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 62844.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8718.0, "maximum": 59948.34, "discounted_cash": 8718.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 18163.78, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 17972.4, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 32719.03, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 17972.4, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 32719.03, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 8718.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 10690.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 10794.47, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 10794.47, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 10586.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 18163.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10586.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 10898.27, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 23249.63, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10898.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 47576.64, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 23314.86, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10379.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 59948.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6958.87, "maximum": 40494.63, "discounted_cash": 13165.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 12269.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 6958.87, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 12668.72, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 6958.87, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 12668.72, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 13165.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 7221.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7291.59, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7291.59, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 7151.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 12269.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7151.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7361.7, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 15704.95, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7361.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 32137.65, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 15749.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7011.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 40494.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [{"code": "281", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8200.48, "maximum": 47363.98, "discounted_cash": 12691.0, "estimated_discounted_cash": 97533.61, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 14350.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 24079.2, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 43836.54, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 24079.2, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 43836.54, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 12691.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8446.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8528.5, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8528.5, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8364.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 14350.84, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8364.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8610.5, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 18369.08, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8610.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 37589.35, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 18420.6, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8200.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 47363.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [{"code": "280", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14312.25, "maximum": 82664.09, "discounted_cash": 17187.0, "estimated_discounted_cash": 72584.44, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 25046.44, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 31080.35, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 56582.23, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 31080.35, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 56582.23, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 17187.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 14741.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 14884.74, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 14884.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 14598.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 25046.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 15027.86, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 32059.44, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15027.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 65604.48, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 32149.37, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14312.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 82664.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [{"code": "282", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6451.71, "maximum": 37263.51, "discounted_cash": 11261.0, "estimated_discounted_cash": 102212.43, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 11290.49, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 18588.69, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 33840.99, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 18588.69, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 33840.99, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 11261.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 6645.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 6709.78, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 6709.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 6580.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 11290.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6580.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 6774.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 14451.83, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6774.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 29573.34, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 14492.37, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6451.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 37263.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [{"code": "284", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6176.01, "maximum": 38450.22, "discounted_cash": 11597.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 10808.02, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 21120.52, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 38450.22, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 21120.52, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 38450.22, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 11597.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 6361.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 6423.05, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 6423.05, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 6299.53, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 10808.02, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6299.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 6484.81, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 13834.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6484.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 28309.6, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 13873.07, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6176.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 35671.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [{"code": "283", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17673.27, "maximum": 102076.57, "discounted_cash": 26747.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 30928.22, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 41275.96, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 75143.49, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 41275.96, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 75143.49, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 26747.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 18203.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 18380.2, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 18380.2, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 18026.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 30928.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18026.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 18556.93, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 39588.12, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18556.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 81010.76, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 39699.19, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17673.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 102076.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5343.56, "maximum": 30863.11, "discounted_cash": 10034.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 9351.23, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 11342.01, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 20648.29, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 11342.01, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 20648.29, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 10034.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5503.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5557.3, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5557.3, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5450.43, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 9351.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5450.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5610.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 11969.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5610.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 24493.81, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12003.15, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5343.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30863.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE NURSING FACILITY CARE", "code_information": [{"code": "G9685", "type": "HCPCS"}], "standard_charges": [{"minimum": 194.2, "maximum": 194.2, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 194.2, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE PVD", "code_information": [{"code": "M1337", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 234.86, "maximum": 2697.23, "discounted_cash": 253.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1986.8, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 246.6, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 527.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 956.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 527.79, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 956.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 253.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1240.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1252.28, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1252.28, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1228.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2107.21, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1264.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 2697.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1264.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}, {"code": "340", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}, {"code": "349", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VITREOUS HEMORRHAGE", "code_information": [{"code": "M1333", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.9, "gross_charge": 1.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 0.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 0.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 0.34, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 0.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 0.3, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 0.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 0.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.9, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 0.9, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 0.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.9, "gross_charge": 1.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 0.36, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 0.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 0.32, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 0.34, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 0.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 0.3, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 0.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 0.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 0.58, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.9, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 0.9, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 0.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 16.49, "maximum": 36.94, "discounted_cash": 36.79, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 18.76, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 36.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 16.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 17.15, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 17.15, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 16.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}], "standard_charges": [{"minimum": 7.13, "maximum": 38.59, "discounted_cash": 38.59, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 27.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 38.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 29.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 37.79, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": 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16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 16.87, "maximum": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPT BEHAVIOR TX PHYS/QHP", "code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 107.45, "maximum": 369.78, "discounted_cash": 107.45, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 272.38, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 107.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 170.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 288.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 369.78, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT BHV TX EA 15 MIN", "code_information": [{"code": "373T", "type": "CPT"}], "standard_charges": [{"minimum": 34.85, "maximum": 78.06, "discounted_cash": 37.66, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 57.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 60.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 78.06, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 94.49, "maximum": 211.66, "discounted_cash": 107.45, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 107.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 97.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 98.27, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 98.27, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 165.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 99.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 211.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 99.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD 30 MINS COUNSEL", "code_information": [{"code": "G2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.8, "maximum": 29.8, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.8, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD CLASP TO PARTIAL DENTURE", "code_information": [{"code": "D5660", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.02, "maximum": 92.02, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.02, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD METAL SUB TO ACRYLC DENT", "code_information": [{"code": "D5876", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.97, "maximum": 83.97, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 83.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD PROC CONSTRUCT NEW CROWN", "code_information": [{"code": "D2971", "type": "HCPCS"}], "standard_charges": [{"minimum": 601.28, "maximum": 1346.87, "discounted_cash": 1071.79, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 992.11, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1071.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 619.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 625.33, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 625.33, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 613.31, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1052.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 613.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 631.34, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1346.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 631.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 601.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $44005 pay 9.40% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 9.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $44005 pay 9.40% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 9.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $44005 pay 9.40% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 9.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TOOTH TO PARTIAL DENTURE", "code_information": [{"code": "D5650", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.81, "maximum": 76.81, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 76.81, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 151.14, "maximum": 366.57, "discounted_cash": 206.5, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 249.38, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 202.28, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 366.57, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 202.28, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 366.57, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 206.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 155.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 157.19, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 157.19, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 154.16, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 264.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 154.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 158.7, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 158.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SUPL MATRL&STAF TM PHE", "code_information": [{"code": "99072", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA DETECTED SCREENING", "code_information": [{"code": "3775F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA NOT DETECT SCREENING", "code_information": [{"code": "3776F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOSINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.58, "maximum": 3.6, "gross_charge": 4.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 2.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 2.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 2.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 2.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 2.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 2.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1.36, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1.2, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1.2, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1.0, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1.0, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 0.58, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 2.34, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 0.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3.6, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 3.6, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 2.4, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 0.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.58, "maximum": 3.6, "gross_charge": 4.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 2.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 2.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 2.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 2.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 2.35, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 2.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1.36, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1.2, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1.2, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1.0, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1.0, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 0.58, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 2.34, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 0.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3.6, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 3.6, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 2.4, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 0.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 35.0, "discounted_cash": 35.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 16.23, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 20.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 14.43, "maximum": 32.32, "discounted_cash": 31.41, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 16.23, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 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"standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 12.87, "maximum": 34.09, "discounted_cash": 34.09, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 34.09, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 13.51, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 15.46, "maximum": 48.74, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 16.23, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 38.08, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 48.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHERE TX ASSESS AT LST ANN", "code_information": [{"code": "G8851", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"minimum": 1052.28, "maximum": 1052.28, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1052.28, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 8151.0, "maximum": 21295.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 16901.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 8151.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 21295.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIVE BANDAGE, FIRST-AID", "code_information": [{"code": "A6413", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.31, "maximum": 0.31, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.31, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADIT MDD DYS REM 12 MNTHS", "code_information": [{"code": "G9509", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"minimum": 1339.05, "maximum": 15117.4, "discounted_cash": 4635.81, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 11135.59, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1406.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 4062.31, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 7361.82, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 4062.31, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 7361.82, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 4635.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 6951.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7018.79, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7018.79, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 6883.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 11810.47, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6883.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7086.28, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 15117.4, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7086.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6748.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUST MAX PROST APPLIANCE", "code_information": [{"code": "D5992", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.72, "maximum": 45.72, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.72, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUST SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9948", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.37, "maximum": 46.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE CHAIR FOR ESRD PT", "code_information": [{"code": "E1570", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.0, "maximum": 187.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.62, "maximum": 67.62, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV HRMNL THXPY RXD", "code_information": [{"code": "4164F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV THXPYRXD/RCVD COLON CA", "code_information": [{"code": "4180F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV TRTMT CHEMO HER2", "code_information": [{"code": "G2206", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS NO RS 12 MO", "code_information": [{"code": "M1020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS RS 12 PHQ<5", "code_information": [{"code": "M1019", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADLT DISP UND/PULL ON ABV XL", "code_information": [{"code": "T4544", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 218.99, "maximum": 218.99, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.99, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.28, "maximum": 130.28, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.28, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"minimum": 145.69, "maximum": 145.69, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 247.86, "maximum": 247.86, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.85, "maximum": 78.06, "discounted_cash": 38.49, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 57.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 38.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 60.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 78.06, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SQ INFUSION DRUG IN HOME", "code_information": [{"code": "G0069", "type": "HCPCS"}], "standard_charges": [{"minimum": 227.42, "maximum": 227.42, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 227.42, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"minimum": 176.03, "maximum": 176.03, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1246.0, "maximum": 3252.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 2582.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 1246.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 3252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}, {"code": "269", "type": "RC"}], "standard_charges": [{"minimum": 1246.0, "maximum": 3252.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 2582.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 1246.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 3252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1246.0, "maximum": 3252.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 2582.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 1246.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 3252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}, {"code": "269", "type": "RC"}], "standard_charges": [{"minimum": 1246.0, "maximum": 3252.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 2582.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 1246.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 3252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 32.52, "maximum": 32.52, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 259.0, "maximum": 674.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 535.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 674.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HOME SLEEP APNEA TEST", "code_information": [{"code": "D9956", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMISSION TO MCCM", "code_information": [{"code": "G9480", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9410", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ SURG REV", "code_information": [{"code": "G9412", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 10.0, "maximum": 17.18, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 17.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"minimum": 31.2, "maximum": 84.67, "discounted_cash": 46.52, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 62.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 32.76, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 38.76, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 41.05, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 38.76, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 41.05, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 46.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 84.67, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADO-TRASTUZUMAB PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9354", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 22.12, "maximum": 97.2, "gross_charge": 108.0, "discounted_cash": 48.74, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 63.33, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 54.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 63.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 54.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 38.88, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 63.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 63.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 54.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 48.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 34.77, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 39.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 36.72, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 63.19, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 67.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.2, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 97.2, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 64.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 85.97, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADO-TRASTUZUMAB PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9354", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 22.12, "maximum": 97.2, "gross_charge": 108.0, "discounted_cash": 48.74, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 63.33, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 54.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 63.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 54.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 38.88, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 63.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 63.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 54.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 48.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 34.77, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 39.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 36.72, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 63.19, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 67.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.2, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 97.2, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 64.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 85.97, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 40.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 40.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 40.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADOPTIVE IMMUNOTHERAPY", "code_information": [{"code": "S2107", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADR DEP THRPY PRESCRIBED", "code_information": [{"code": "G9894", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 3295.94, "maximum": 7382.91, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 5438.3, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3394.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3427.78, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3427.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3361.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 5767.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3361.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3460.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 7382.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3460.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 3295.94, "maximum": 7382.91, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 5438.3, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3394.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3427.78, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3427.78, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3361.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 5767.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3361.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3460.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 7382.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3460.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3295.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 11523.0, "maximum": 30105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 23893.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 11523.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 30105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19555.88, "maximum": 112950.03, "discounted_cash": 31075.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 34222.79, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 37006.65, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 67371.14, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 37006.65, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 67371.14, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 31075.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 20142.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 20338.12, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 20338.12, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 19947.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 34222.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19947.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 20533.67, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 43805.17, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20533.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 89640.24, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 43928.06, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19555.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 112950.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12484.96, "maximum": 72110.13, "discounted_cash": 28237.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 21848.68, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 27307.0, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 49712.79, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 27307.0, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 49712.79, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 28237.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12859.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12984.36, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12984.36, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12734.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 21848.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12734.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 13109.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 27966.31, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13109.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 57228.57, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 28044.77, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12484.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 72110.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 283.67, "maximum": 5136.2, "discounted_cash": 995.9, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1986.8, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 297.85, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 2834.2, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 5136.2, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 2834.2, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 5136.2, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 995.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1240.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1252.28, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1252.28, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 283.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1228.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2107.21, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 283.67, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1264.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 2697.23, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 283.67, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1264.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}, {"code": "340", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}, {"code": "349", "type": "RC"}], "standard_charges": [{"minimum": 1305.94, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Rad FS #34792 at 100%", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 1305.37, "maximum": 2924.03, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2153.86, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1344.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1357.58, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1357.58, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1331.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2284.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1331.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1370.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 2924.03, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1370.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 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#34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADT 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT NO 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT PD OUT MAT PR 180 DYS TX", "code_information": [{"code": "M1035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT TKNG PHARMTHRY FOR OUD", "code_information": [{"code": "M1032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER 15M", "code_information": [{"code": "S5135", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.09, "maximum": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER DIEM", "code_information": [{"code": "S5136", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.71, "maximum": 15.71, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.71, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER DIEM", "code_information": [{"code": "S5102", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER HALF DAY", "code_information": [{"code": "S5101", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.12, "maximum": 13.12, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAYCARE SERVICES 15MIN", "code_information": [{"code": "S5100", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.19, "maximum": 2.19, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DISP BRIEF/DIAP ABV XL", "code_information": [{"code": "T4543", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.76, "maximum": 0.76, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER DIEM", "code_information": [{"code": "S5140", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.0, "maximum": 37.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER MONTH", "code_information": [{"code": "S5141", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.61, "maximum": 10.61, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4523", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER MED", "code_information": [{"code": "T4522", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER SM", "code_information": [{"code": "T4521", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER XL", "code_information": [{"code": "T4524", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON LG", "code_information": [{"code": "T4527", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON MED", "code_information": [{"code": "T4526", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON SM", "code_information": [{"code": "T4525", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON XL", "code_information": [{"code": "T4528", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SPEECH AID", "code_information": [{"code": "D5953", "type": "HCPCS"}], "standard_charges": [{"minimum": 2710.75, "maximum": 2710.75, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2710.75, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV CARE HEART DX MVP", "code_information": [{"code": "G0055", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV DEM CRGVR LIMITED", "code_information": [{"code": "G9917", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV RHEUM PT CARE MVP", "code_information": [{"code": "G0053", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCED LIFE SUPPORT MILEAG", "code_information": [{"code": "A0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.68, "maximum": 3.68, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCING CANCER CARE MVP", "code_information": [{"code": "M0001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN IN RCRD", "code_information": [{"code": "1157F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN TLK DOCD", "code_information": [{"code": "1158F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN 30 MIN", "code_information": [{"code": "99497", "type": "CPT"}], "standard_charges": [{"minimum": 94.49, "maximum": 211.66, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 97.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 98.27, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 98.27, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 165.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 99.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 211.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 99.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN ADDL 30 MIN", "code_information": [{"code": "99498", "type": "CPT"}], "standard_charges": [{"minimum": 71.57, "maximum": 71.57, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}], "standard_charges": [{"minimum": 200.83, "maximum": 449.86, "discounted_cash": 252.56, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 331.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 221.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 400.64, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 221.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 400.64, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 252.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 206.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 208.86, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 208.86, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 351.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 210.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 449.86, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}, {"code": "470", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}, {"code": "472", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}, {"code": "479", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}], "standard_charges": [{"minimum": 200.83, "maximum": 900.84, "discounted_cash": 567.15, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 331.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 497.09, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 900.84, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 497.09, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 900.84, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 567.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 206.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 208.86, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 208.86, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 351.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 210.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 449.86, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}, {"code": "470", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}, {"code": "472", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}, {"code": "479", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"minimum": 27.66, "maximum": 400.64, "discounted_cash": 252.56, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.66, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 221.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 400.64, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 221.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 400.64, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 252.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}, {"code": "470", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}, {"code": "472", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}, {"code": "479", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}], "standard_charges": [{"minimum": 200.83, "maximum": 900.84, "discounted_cash": 567.15, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 331.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 497.09, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 900.84, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 497.09, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 900.84, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 567.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 206.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 208.86, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 208.86, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 351.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 210.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 449.86, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}, {"code": "470", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}, {"code": "472", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}, {"code": "479", "type": "RC"}], "standard_charges": [{"minimum": 401.0, "maximum": 1051.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}], "standard_charges": [{"minimum": 203.67, "maximum": 469.92, "discounted_cash": 295.76, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 336.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 259.3, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 469.92, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 259.3, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 469.92, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 295.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 209.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 207.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 356.42, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 456.22, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}, {"code": "412", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}, {"code": "419", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}, {"code": "948", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}], "standard_charges": [{"minimum": 2592.05, "maximum": 6002.24, "discounted_cash": 4114.07, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 4421.29, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 3255.18, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 2592.05, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 3490.55, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 2592.05, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 3490.55, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 4114.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 2759.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 2786.75, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 2786.75, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3100.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 2733.16, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 4689.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 3100.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2733.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 2813.55, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 6002.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 3100.17, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2813.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2679.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 2873.33, "maximum": 2873.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 2873.33, "maximum": 2873.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2873.33, "maximum": 2873.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 2873.33, "maximum": 2873.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 2873.33, "maximum": 2873.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 2873.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 306.88, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 226.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 141.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 142.48, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 142.48, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 139.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 239.75, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 139.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 306.88, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 615.62, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 453.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 283.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 285.82, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 285.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 480.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 615.62, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFFINITY1 SQUARE CM", "code_information": [{"code": "Q4159", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 215.21, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 204.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 204.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 204.96, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}], "standard_charges": [{"minimum": 702.4, "maximum": 1730.26, "discounted_cash": 1730.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1158.96, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 810.14, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 806.23, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1461.06, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 806.23, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1461.06, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1730.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 723.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 730.5, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 730.5, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 716.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1229.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 716.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 737.52, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1573.38, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 737.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 801.07, "maximum": 801.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 801.07, "maximum": 801.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 801.07, "maximum": 801.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 801.07, "maximum": 801.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 801.07, "maximum": 801.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 801.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.16, "maximum": 27.47, "discounted_cash": 18.83, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 21.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 27.47, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 24.78, "maximum": 24.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 24.78, "maximum": 24.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 24.78, "maximum": 24.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 24.78, "maximum": 24.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 24.78, "maximum": 24.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFO PLSTC/OTHER PREFAB", "code_information": [{"code": "L1930", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 271.84, "maximum": 3159.0, "gross_charge": 3510.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 448.54, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 934.01, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 1755.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 2063.88, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 1755.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1263.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 2063.88, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 2063.88, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 1755.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 593.19, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1074.06, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 593.19, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1074.06, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1755.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1130.22, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1193.4, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 282.71, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 282.71, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 889.43, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 2053.7, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 277.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 475.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 889.43, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 277.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 2106.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 285.43, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 608.92, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 889.43, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 285.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $44005 pay 9.40% POC", "standard_charge_dollar": 329.94, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $44005 pay 9.40% POC", "standard_charge_dollar": 329.94, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 271.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $44005 pay 9.40% POC", "standard_charge_dollar": 329.94, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}], "standard_charges": [{"minimum": 511.54, "maximum": 1779.42, "discounted_cash": 872.9, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 844.04, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1406.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 981.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 1779.42, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 981.89, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 1779.42, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 872.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 526.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 521.77, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 895.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 521.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 537.12, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1145.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1339.05, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 537.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 511.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 3060.0, "maximum": 7993.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 6344.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 3060.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 7993.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10614.85, "maximum": 61308.81, "discounted_cash": 23772.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 18575.99, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 23085.66, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 42027.78, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 23085.66, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 42027.78, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 23772.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 10933.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 11039.44, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 11039.44, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 10827.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 18575.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10827.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 11145.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 23777.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11145.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 48656.35, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 23843.97, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10614.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 61308.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5600.52, "maximum": 32347.26, "discounted_cash": 13343.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 9800.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 10522.45, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 19156.28, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 10522.45, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 19156.28, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 13343.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5768.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5824.54, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5824.54, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5712.53, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 9800.91, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5712.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5880.55, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 12545.16, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5880.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25671.67, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12580.36, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5600.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 32347.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10047.39, "maximum": 58031.31, "discounted_cash": 18868.0, "estimated_discounted_cash": 21390.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 17582.93, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 18265.1, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 33251.88, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 18265.1, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 33251.88, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 18868.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 10348.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 10449.29, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 10449.29, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 10248.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 17582.93, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10248.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 10549.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 22506.15, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10549.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 46055.24, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 22569.3, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10047.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 58031.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16639.18, "maximum": 96103.89, "discounted_cash": 22490.0, "estimated_discounted_cash": 120779.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 29118.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 31957.63, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 58179.33, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 31957.63, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 58179.33, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 22490.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 17138.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 17304.75, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 17304.75, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 16971.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 29118.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16971.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 17471.14, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 37271.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17471.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 76270.68, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 37376.33, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16639.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 96103.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7172.63, "maximum": 41427.38, "discounted_cash": 10789.0, "estimated_discounted_cash": 79285.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 12552.1, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 9388.25, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 17091.45, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 9388.25, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 17091.45, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 10789.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 7387.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7459.54, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7459.54, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 7316.08, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 12552.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7316.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7531.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 16066.69, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7531.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 32877.9, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 16111.76, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7172.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 41427.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 30.0, "discounted_cash": 30.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 16.23, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 20.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.52, "maximum": 469.32, "discounted_cash": 249.24, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 345.71, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 235.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 249.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 215.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 217.9, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 217.9, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 224.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 213.71, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 366.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 224.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 213.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 220.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 469.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 224.29, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 220.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 223.52, "maximum": 223.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 223.52, "maximum": 223.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 223.52, "maximum": 223.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 223.52, "maximum": 223.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 223.52, "maximum": 223.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}], "standard_charges": [{"minimum": 15.46, "maximum": 51.07, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 26.52, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 16.23, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 28.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGENT NOS ASSAY W/OPTIC", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}], "standard_charges": [{"minimum": 6.98, "maximum": 37.37, "discounted_cash": 37.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 9.45, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 37.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 7.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 6.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.61, "maximum": 18.83, "discounted_cash": 18.83, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 50% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AHI OR RDI INITIAL DX", "code_information": [{"code": "G8842", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"minimum": 840.65, "maximum": 1883.06, "setting": "outpatient", 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data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 840.65, "methodology": "fee 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combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 882.68, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1883.06, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding 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"All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 840.65, "maximum": 840.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 840.65, "maximum": 840.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", 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{"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 840.65, "maximum": 840.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 840.65, "maximum": 840.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 840.65, "maximum": 840.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 1702.4, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 782.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 790.4, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 790.4, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 775.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1330.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 775.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1702.4, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}], "standard_charges": [{"minimum": 3675.0, "maximum": 8232.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 6063.75, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3748.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 6431.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3748.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3858.75, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 8232.0, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3858.75, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3675.0, "maximum": 3675.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 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"plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 3675.0, "maximum": 3675.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}], "standard_charges": [{"minimum": 380.72, "maximum": 852.81, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 628.19, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 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charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 392.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 395.95, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 395.95, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 388.33, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 666.26, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 388.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 399.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 852.81, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 399.76, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": 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"AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 380.72, "maximum": 380.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AICD GENERATOR PROCEDURES", "code_information": [{"code": "245", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40707.06, "maximum": 235114.16, "discounted_cash": 76438.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 71237.36, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 47519.34, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 86509.67, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 47519.34, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 86509.67, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 76438.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 41928.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 42335.34, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 42335.34, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 41521.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 71237.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41521.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 42742.41, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 91183.81, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42742.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 186593.04, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 91439.62, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40707.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 235114.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AICD LEAD PROCEDURES", "code_information": [{"code": "265", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21266.06, "maximum": 186456.7, "discounted_cash": 38215.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 56494.6, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 21266.06, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 38715.17, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 21266.06, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 38715.17, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 38215.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 33251.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 33573.94, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 33573.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 32928.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 56494.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32928.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 33896.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 72313.09, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33896.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 147977.14, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 72515.96, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32282.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 186456.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $20330 pay 20.20% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.2, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULAN NONEMERG ROTARY", "code_information": [{"code": "S9961", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULANC NONEMERG FIXED", "code_information": [{"code": "S9960", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR ELEVATOR FOR HEEL", "code_information": [{"code": "E0370", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.0, "maximum": 8.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 439.0, "maximum": 1147.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 911.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 439.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 1147.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIRWAY INHALATION TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}], "standard_charges": [{"minimum": 8.92, "maximum": 456.22, "discounted_cash": 85.29, "estimated_discounted_cash": 528.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 336.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 83.4, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 151.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 83.4, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 151.12, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 85.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 209.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 207.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 356.42, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 456.22, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWAY INHALATION TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "estimated_discounted_cash": 528.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWAY INHALATION TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "412", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "estimated_discounted_cash": 528.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWAY INHALATION TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "419", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "estimated_discounted_cash": 528.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWAY INHALATION TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "948", "type": "RC"}], "standard_charges": [{"minimum": 241.0, "maximum": 630.0, "estimated_discounted_cash": 528.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 241.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}], "standard_charges": [{"minimum": 104.95, "maximum": 268.08, "discounted_cash": 119.63, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 197.47, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 104.95, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 190.19, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 104.95, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 190.19, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 119.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 125.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 268.08, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 912.0, "maximum": 2385.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 1892.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}, {"code": "469", "type": "RC"}], "standard_charges": [{"minimum": 912.0, "maximum": 2385.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 1892.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG I: T1 MIC/T1A", "code_information": [{"code": "G9704", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG IB", "code_information": [{"code": "G9705", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 0 DOCD", "code_information": [{"code": "3370F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3372F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3374F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 2 DOCD", "code_information": [{"code": "3376F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 3 DOCD", "code_information": [{"code": "3378F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 4 DOCD", "code_information": [{"code": "3380F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 0 DOCD", "code_information": [{"code": "3382F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 1 DOCD", "code_information": [{"code": "3384F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 2 DOCD", "code_information": [{"code": "3386F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 3 DOCD", "code_information": [{"code": "3388F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 4 DOCD", "code_information": [{"code": "3390F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CNCR 0/IA MELAN DOCD", "code_information": [{"code": "3321F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC MEL CNR STG 0 - IIC", "code_information": [{"code": "G8944", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STAGE DOCD B/4 THXPY", "code_information": [{"code": "3300F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STG BRT CA DX II OR III", "code_information": [{"code": "G9831", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $44005 pay 9.40% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 9.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $44005 pay 9.40% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 9.4, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $44005 pay 9.40% POC No historical data found for payer/plan and coding combination", "standard_charge_percentage": 9.4, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}], "standard_charges": [{"minimum": 5.3, "maximum": 101.33, "discounted_cash": 16.99, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 55.92, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 55.92, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 16.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 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FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO (ALT) (SGPT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 5.3, "estimated_discounted_cash": 225.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-1+ PRSNT", "code_information": [{"code": "1071F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-ABSENT", "code_information": [{"code": "1070F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALATROFLOXACIN MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.43, "maximum": 16.43, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.43, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.33, "maximum": 43.3, "discounted_cash": 29.91, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 31.89, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 29.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 19.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 43.3, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 21.23, "maximum": 21.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 21.23, "maximum": 21.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 21.23, "maximum": 21.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 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{"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 25% PER 50ML IJ", "code_information": [{"code": "P9047", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 48.32, "maximum": 329.4, "gross_charge": 366.0, "estimated_discounted_cash": 1625.41, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 79.73, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 215.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 183.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 61.85, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 111.99, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 61.85, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", 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"Humana", "plan_name": "Medicaid", "standard_charge_dollar": 92.74, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 214.14, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 92.74, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 329.4, "methodology": "percent of total 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"ALBUMIN 25% PER 50ML IJ", "code_information": [{"code": "P9047", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 48.32, "maximum": 329.4, "gross_charge": 366.0, "estimated_discounted_cash": 1625.41, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 79.73, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 97.39, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 183.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", 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"plan_name": "MMP", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 92.74, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 329.4, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 329.4, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 219.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 108.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 92.74, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 5% PER 250ML IJ", "code_information": [{"code": "P9045", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 48.32, "maximum": 418.5, "gross_charge": 465.0, "discounted_cash": 75.32, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 79.73, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 123.73, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 232.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 273.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 232.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 167.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 273.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 273.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 232.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 78.58, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 142.29, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 78.58, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 142.29, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 75.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 149.73, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 49.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 158.1, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 50.25, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 50.25, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 117.83, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 272.07, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 84.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 117.83, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 108.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 117.83, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 5% PER 250ML IJ", "code_information": [{"code": "P9045", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 48.32, "maximum": 418.5, "gross_charge": 465.0, "discounted_cash": 75.32, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 79.73, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 123.73, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 232.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 273.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 232.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 167.4, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 273.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 273.42, "methodology": "percent of 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"methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 108.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 117.83, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 5% PER 50ML IJ", "code_information": [{"code": "P9041", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.67, "maximum": 850.5, "gross_charge": 945.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 251.46, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 472.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 555.66, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 472.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 555.66, "methodology": "percent of total 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charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 289.17, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 304.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 321.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 239.46, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 552.91, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 239.46, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 239.46, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 5% PER 50ML IJ", "code_information": [{"code": "P9041", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.67, "maximum": 850.5, "gross_charge": 945.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 251.46, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 472.5, "methodology": "percent of total 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"Cigna", "plan_name": "PPO", "standard_charge_dollar": 321.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 239.46, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 552.91, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 239.46, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 239.46, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 33.94, "maximum": 76.03, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 45.95, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 34.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 35.3, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 35.3, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 34.62, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 59.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 76.03, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 33.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.19, "maximum": 1.19, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.48, "maximum": 0.48, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL HFA 8.5GM IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 7.6, "maximum": 40.5, "gross_charge": 45.0, 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"methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 62.32, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 53.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 17.91, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 32.43, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 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"Commercial", "standard_charge_dollar": 63.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 26.86, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 30.25, "maximum": 161.1, "gross_charge": 179.0, "discounted_cash": 148.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 47.63, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 89.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 105.25, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 89.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", 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{"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 53.7, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 44.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 44.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 45.35, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 104.73, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 45.35, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 161.1, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 161.1, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 107.4, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 45.35, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 39.2, "maximum": 208.8, "gross_charge": 232.0, "discounted_cash": 148.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 61.73, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 116.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 136.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 116.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 83.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 136.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 136.41, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 116.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 39.2, "methodology": "percent of total billed 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billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 139.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 119.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 85.68, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 139.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 139.94, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 119.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross 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76.63, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 80.92, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 71.4, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 71.4, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 59.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 59.5, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 60.3, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 139.25, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 60.3, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 60.3, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 42.41, "maximum": 225.9, "gross_charge": 251.0, "discounted_cash": 148.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 66.79, 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"standard_charge_dollar": 556.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 400.68, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 654.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 556.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 654.44, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 556.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 188.09, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield 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"Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 333.9, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 333.9, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 278.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 278.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 282.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 651.21, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 282.03, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1001.7, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 1001.7, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 667.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 282.03, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.18, "maximum": 0.21, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.18, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.16, "maximum": 0.16, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG ASSESS", "code_information": [{"code": "H0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.62, "maximum": 43.62, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG HOTLINE", "code_information": [{"code": "H0030", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.76, "maximum": 4.76, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG INTERVEN", "code_information": [{"code": "H0022", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.37, "maximum": 25.37, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.37, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG OUTREACH", "code_information": [{"code": "H0023", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.0, "maximum": 160.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0024", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.35, "maximum": 11.35, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0025", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.9, "maximum": 7.9, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0026", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.55, "maximum": 27.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0027", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0029", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.38, "maximum": 144.38, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 144.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.44, "maximum": 45.44, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0003", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0004", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.62, "maximum": 23.62, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.35, "maximum": 54.35, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0006", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.1, "maximum": 8.1, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0007", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.4, "maximum": 11.4, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.0, "maximum": 112.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 481.6, "maximum": 481.6, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 481.6, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.93, "maximum": 120.93, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 120.93, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.08, "maximum": 314.08, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 314.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.24, "maximum": 74.24, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 501.86, "maximum": 501.86, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 501.86, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}], "standard_charges": [{"minimum": 204.91, "maximum": 204.91, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.91, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.47, "maximum": 124.47, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 124.47, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0016", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.38, "maximum": 30.38, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 336.06, "maximum": 336.06, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 336.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0018", "type": "HCPCS"}], "standard_charges": [{"minimum": 270.16, "maximum": 270.16, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 270.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0019", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.3, "maximum": 110.3, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 110.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0020", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.26, "maximum": 24.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG TRAINING", "code_information": [{"code": "H0021", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.66, "maximum": 4.66, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL OR PEROXIDE PER PINT", "code_information": [{"code": "A4244", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.74, "maximum": 0.74, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL WIPES PER BOX", "code_information": [{"code": "A4245", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.21, "maximum": 2.21, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.21, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12630.39, "maximum": 72950.11, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 22103.18, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 13009.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 13135.61, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 13135.61, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12883.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 22103.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12883.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 13261.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 28292.07, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13261.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 57895.21, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 28371.46, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12630.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 72950.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15570.29, "maximum": 89930.24, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 27248.01, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 16037.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 16193.1, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 16193.1, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 15881.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 27248.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15881.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 16348.8, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 34877.45, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16348.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 71371.1, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 34975.29, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15570.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 89930.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7876.6, "maximum": 45493.33, "estimated_discounted_cash": 57458.33, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 13784.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 10274.47, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 18704.83, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 10274.47, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 18704.83, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8112.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8191.66, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8191.66, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8034.13, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 13784.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8034.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8270.43, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 17643.58, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8270.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 36104.75, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 17693.08, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7876.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 45493.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5504.16, "maximum": 31790.71, "estimated_discounted_cash": 57054.5, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 9632.28, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5669.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5724.33, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5724.33, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5614.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 9632.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5614.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5779.37, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 12329.32, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5779.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 25229.98, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 12363.91, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5504.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 31790.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG ABUSE SVC NOS", "code_information": [{"code": "H0047", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SCREENING", "code_information": [{"code": "H0049", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SERVICE 15 MIN", "code_information": [{"code": "H0050", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.13, "maximum": 23.13, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.13, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUB MISUSE ASSESS", "code_information": [{"code": "G2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.9, "maximum": 60.26, "discounted_cash": 35.45, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 44.39, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 35.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 27.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 27.98, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 27.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 60.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV 15-30MN", "code_information": [{"code": "G0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.85, "maximum": 137.41, "discounted_cash": 86.4, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 57.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 137.41, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 137.41, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 60.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 78.06, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV >30 MIN", "code_information": [{"code": "G0397", "type": "HCPCS"}], "standard_charges": [{"minimum": 75.83, "maximum": 369.78, "discounted_cash": 86.4, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 272.38, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 137.41, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 75.83, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 137.41, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 170.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 288.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 168.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 369.78, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 173.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBSTANCE ABUSE SKIL", "code_information": [{"code": "T1012", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.6, "maximum": 3.6, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.6, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 1OR 2", "code_information": [{"code": "80321", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 3/MORE", "code_information": [{"code": "80322", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD BLU TOOTH FM/DM RECEIVER", "code_information": [{"code": "V5286", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.14, "maximum": 103.14, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 103.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM ADAPT/BOOT COUPLIN", "code_information": [{"code": "V5289", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM AUD INPUT RECEIVER", "code_information": [{"code": "V5285", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM EAR LEVEL RECEIVER", "code_information": [{"code": "V5284", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.88, "maximum": 63.88, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM RECEIVER, NOS", "code_information": [{"code": "V5287", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.33, "maximum": 9.33, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM BINAURAL", "code_information": [{"code": "V5282", "type": "HCPCS"}], "standard_charges": [{"minimum": 824.22, "maximum": 824.22, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 824.22, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM, MONAURAL", "code_information": [{"code": "V5281", "type": "HCPCS"}], "standard_charges": [{"minimum": 1356.79, "maximum": 1356.79, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1356.79, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM TRANSMITTER ALD", "code_information": [{"code": "V5288", "type": "HCPCS"}], "standard_charges": [{"minimum": 254.67, "maximum": 254.67, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.67, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FOR COCHLEAR IMPLANT", "code_information": [{"code": "V5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 691.75, "maximum": 691.75, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 691.75, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD NECK, LOOP IND RECEIVER", "code_information": [{"code": "V5283", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TELEPHONE AMPLIFIER", "code_information": [{"code": "V5268", "type": "HCPCS"}], "standard_charges": [{"minimum": 222.34, "maximum": 222.34, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.34, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TRANSMITTER MICROPHONE", "code_information": [{"code": "V5290", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD UNSPECIFIED", "code_information": [{"code": "V5274", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV AMPLIFIER, ANY TYPE", "code_information": [{"code": "V5270", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.27, "maximum": 128.27, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 128.27, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV CAPTION DECODER", "code_information": [{"code": "V5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1400.0, "maximum": 1400.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1400.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}], "standard_charges": [{"minimum": 1550.81, "maximum": 6808.64, "discounted_cash": 1550.81, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 5015.29, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 6261.19, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 1550.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 3130.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 3161.15, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 3161.15, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5963.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 3100.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 5319.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 5963.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3100.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 3191.55, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 6808.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 5963.04, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3191.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3039.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 5301.26, "maximum": 5301.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 5301.26, "maximum": 5301.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5301.26, "maximum": 5301.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 5301.26, "maximum": 5301.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 5301.26, "maximum": 5301.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5301.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 125.5, "maximum": 323.98, "discounted_cash": 323.98, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 207.08, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 166.7, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 323.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 129.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 130.52, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 130.52, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 158.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 219.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 158.76, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 131.78, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 281.12, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 158.76, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 131.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 125.5, "maximum": 125.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.65, "maximum": 73.11, "discounted_cash": 73.11, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 41.69, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.65, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 73.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 39.7, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 39.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 39.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALERT DEVICE, NOC", "code_information": [{"code": "A9280", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALERTING DEVICE, ANY TYPE", "code_information": [{"code": "V5269", "type": "HCPCS"}], "standard_charges": [{"minimum": 237.83, "maximum": 237.83, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 237.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGINATE DRESSING > 48 SQ IN", "code_information": [{"code": "A6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.0, "maximum": 20.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.02, "maximum": 74.22, "discounted_cash": 74.22, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.02, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 74.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.88, "maximum": 225.23, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 225.23, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.88, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALKALOIDS NOS", "code_information": [{"code": "80323", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}], "standard_charges": [{"minimum": 6.72, "maximum": 28.8, "discounted_cash": 28.8, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 7.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 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"standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14248.0, "maximum": 86657.89, "discounted_cash": 14248.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 26256.51, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 19774.12, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 35999.07, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 19774.12, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 35999.07, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 14248.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 15453.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 15603.87, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 15603.87, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 15303.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 26256.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15303.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 15753.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 33608.33, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15753.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 68774.08, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 33702.63, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15003.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 86657.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5944.92, "maximum": 34336.44, "discounted_cash": 6119.0, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 10403.61, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 6641.78, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 12091.46, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 6641.78, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 12091.46, "methodology": "case rate"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "Pay $5200 PD once trim day is exceeded", "standard_charge_dollar": 6119.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 6123.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 6182.72, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 6182.72, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 6063.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 10403.61, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6063.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 6242.17, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 13316.62, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6242.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 27250.34, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 13353.98, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5944.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 34336.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 3.16, "maximum": 1789.09, "discounted_cash": 75.32, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 1317.86, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 3.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 65.59, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 118.85, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 65.59, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 118.85, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 75.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 822.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 830.65, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 830.65, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 814.67, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 1397.73, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 814.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 838.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 1789.09, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 838.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 798.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGY/IMMUNOLOGY SS", "code_information": [{"code": "G0060", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}], "standard_charges": [{"minimum": 5.22, "maximum": 24.05, "discounted_cash": 24.05, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 7.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 19.43, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 19.43, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 9.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE CRUDE XTRC EA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 5.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 4.59, "maximum": 21.33, "discounted_cash": 21.33, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 4.82, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee 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"standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 7.97, "maximum": 7.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG 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"payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}], "standard_charges": [{"minimum": 17.71, "maximum": 41.49, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 29.58, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 18.65, "methodology": "fee 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"Molina", "plan_name": "Medicaid", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "300", "type": 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"additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB 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"payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 9179.0, "maximum": 26747.77, "discounted_cash": 10475.71, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 19702.6, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 9179.0, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 16634.41, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 9179.0, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 16634.41, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 10475.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 12299.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 12418.61, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 12418.61, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 12179.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 20896.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12179.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 12538.02, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 26747.77, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12538.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11940.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}, {"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 9465.0, "maximum": 24729.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 19627.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 9465.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 24729.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM (IMPLANT)", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 39.37, "maximum": 259.26, "gross_charge": 233.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 62.0, "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 116.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 137.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 116.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 83.88, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 137.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 137.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 116.5, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 39.37, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 71.29, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 39.37, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 71.29, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 75.02, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 79.22, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 59.04, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 136.32, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 59.04, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 209.7, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 209.7, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 139.8, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 59.04, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGEN, PER CC", "code_information": [{"code": "Q4212", "type": "HCPCS"}], "standard_charges": [{"minimum": 3148.8, "maximum": 3306.24, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 3306.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3148.8, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 3148.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 3148.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"minimum": 107227.19, "maximum": 619318.44, "setting": "inpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 187647.58, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 18.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 33.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 110444.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 111516.28, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 111516.28, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 109371.73, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 187647.58, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 109371.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 112588.55, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 240188.91, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112588.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "standard_charge_dollar": 491508.07, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "standard_charge_dollar": 240862.75, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 107227.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "standard_charge_dollar": 619318.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNTC LIQ ALLOAID RT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 331.25, "maximum": 2137.58, "gross_charge": 1861.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 495.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 930.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 1094.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 930.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 669.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 1094.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 1094.26, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 930.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 599.24, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 632.74, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 558.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 558.3, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 465.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 465.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 471.57, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 1088.87, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 471.57, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1674.9, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 1674.9, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 1116.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 471.57, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 331.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 331.25, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 331.25, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 655.21, "maximum": 3312.9, "gross_charge": 3681.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 979.51, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 1840.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 2164.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 1840.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1325.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 2164.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 2164.42, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 1840.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1185.28, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1251.54, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1104.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1104.3, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 920.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 920.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 932.76, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 2153.75, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 932.76, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3312.9, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 3312.9, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 2208.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 932.76, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 655.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 655.21, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 655.21, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 726.59, "maximum": 3673.8, "gross_charge": 4082.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 1086.22, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 2041.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 2400.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 2041.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1469.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 2400.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 2400.21, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 2041.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 1314.4, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 1387.88, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1224.6, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1224.6, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1020.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1020.5, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1034.37, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 2388.37, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1034.37, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3673.8, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 3673.8, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 2449.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1034.37, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 726.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 726.59, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 726.59, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 1403.53, "maximum": 7096.5, "gross_charge": 7885.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 2098.19, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 3942.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 4636.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 3942.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2838.6, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 4636.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 4636.38, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 3942.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 2538.97, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 2680.9, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 2365.5, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 2365.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1971.25, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1971.25, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 1998.05, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 4613.51, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1998.05, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7096.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 7096.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 4731.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 1998.05, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1403.53, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1403.53, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1403.53, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 1685.12, "maximum": 8520.3, "gross_charge": 9467.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 2519.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 4733.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 5566.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 4733.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3408.12, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 5566.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 5566.59, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 4733.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 3048.37, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3218.78, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 2840.1, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 2840.1, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 2366.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 2366.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2398.93, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 5539.14, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2398.93, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8520.3, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 8520.3, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 5680.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 2398.93, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1685.12, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1685.12, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1685.12, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 1703.46, "maximum": 8613.0, "gross_charge": 9570.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 2546.57, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 4785.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 5627.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 4785.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3445.2, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 5627.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 5627.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 4785.0, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 3081.54, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 3253.8, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 2871.0, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 2871.0, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 2392.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 2392.5, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 2425.03, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 5599.4, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2425.03, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8613.0, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 8613.0, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 5742.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 2425.03, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1703.46, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1703.46, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 1703.46, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 2137.58, "maximum": 14064.3, "gross_charge": 15627.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 4158.34, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 7813.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 9188.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 7813.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 5625.72, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 9188.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 9188.67, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 7813.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 5031.89, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 5313.18, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 4688.1, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 4688.1, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 3906.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 3906.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 3959.88, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 9143.35, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 3959.88, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14064.3, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 14064.3, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 9376.2, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 3959.88, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 2781.6, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 2781.6, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 2781.6, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 2137.58, "maximum": 21919.5, "gross_charge": 24355.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 6480.86, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 12177.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 14320.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 12177.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 8767.8, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 14320.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 14320.74, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 12177.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 7842.31, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 8280.7, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 7306.5, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 7306.5, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 6088.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 6088.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6171.55, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 14250.11, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 6171.55, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21919.5, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 21919.5, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 14613.0, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 6171.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 4335.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 4335.19, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 4335.19, "methodology": "percent of total billed charges"}], "billing_class": "facility"}, {"minimum": 2137.58, "maximum": 99189.9, "gross_charge": 110211.0, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 29327.14, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 55105.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 64804.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 55105.5, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 39675.96, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 64804.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2137.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 64804.06, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 55105.5, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 35487.94, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 37471.74, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 33063.3, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 33063.3, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 27552.75, "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 27552.75, "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 27927.46, "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 64484.45, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 27927.46, "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 99189.9, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 99189.9, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 66126.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 27927.46, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 19617.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 19617.55, "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Threshold $23111 pay 17.80% POC", "standard_charge_dollar": 19617.55, "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4115", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4123", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.74, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN AC, 1 CM", "code_information": [{"code": "Q4141", "type": "HCPCS"}], "standard_charges": [{"minimum": 106.97, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 112.32, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 106.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 106.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 106.97, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [{"code": "Q4150", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.17, "maximum": 259.26, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 119.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 120.37, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 78.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 202.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 78.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 118.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 259.26, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 78.17, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.97, "maximum": 176.18, "discounted_cash": 7.75, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 5.73, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 97.22, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 176.18, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 97.22, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 176.18, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 5.17, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 5.17, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 5.09, "maximum": 5.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 5.09, "maximum": 5.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.09, "maximum": 5.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 5.09, "maximum": 5.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 5.09, "maximum": 5.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}], "standard_charges": [{"minimum": 14.46, "maximum": 68.56, "discounted_cash": 68.56, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 23.86, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 44.54, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 44.54, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 68.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 14.75, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 25.31, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 32.39, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}], "standard_charges": [{"minimum": 9.85, "maximum": 370.06, "discounted_cash": 64.73, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 22.18, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 204.2, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 370.06, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 204.2, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 370.06, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 30.11, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee 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13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "estimated_discounted_cash": 332.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}], "standard_charges": [{"minimum": 7.68, "maximum": 47.02, "discounted_cash": 47.02, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 28.05, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 38.08, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}], "standard_charges": [{"minimum": 64.41, "maximum": 144.28, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 106.28, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 80.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 66.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 66.99, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 66.99, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 76.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 76.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 67.63, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 144.28, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 76.83, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.63, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "303", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}], "standard_charges": [{"minimum": 7.68, "maximum": 332.44, "discounted_cash": 50.54, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 27.67, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 183.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 332.44, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 183.45, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 332.44, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 50.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 29.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 37.56, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 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"additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "307", "type": 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[{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "923", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "925", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "estimated_discounted_cash": 412.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Lab FS #34878 at 100%", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL FOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.46, "maximum": 9.9, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 6.78, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.35, "maximum": 64.07, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 64.07, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 61.02, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 61.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 61.02, "methodology": "fee schedule"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS 1", "code_information": [{"code": "A0426", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.89, "maximum": 188.89, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 188.89, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS 2", "code_information": [{"code": "A0433", "type": "HCPCS"}], "standard_charges": [{"minimum": 594.21, "maximum": 594.21, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 594.21, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0392", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.54, "maximum": 25.54, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.54, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ESOPHAGEAL INTUB SUPPLS", "code_information": [{"code": "A0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.25, "maximum": 20.25, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS IV DRUG THERAPY SUPPLIES", "code_information": [{"code": "A0394", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.19, "maximum": 12.19, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ROUTINE DISPOSBLE SUPPLS", "code_information": [{"code": "A0398", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.06, "maximum": 5.06, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS1-EMERGENCY", "code_information": [{"code": "A0427", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.55, "maximum": 198.55, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 198.55, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Self Pay", "plan_name": "Self Pay", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALT LONG-TERM CNTRL MED RXD", "code_information": [{"code": "4144F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 24.29, "maximum": 230.4, "gross_charge": 256.0, "discounted_cash": 97.48, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 141.87, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 102.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 128.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 150.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 128.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 92.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 150.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 150.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 128.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 44.01, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 44.01, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 97.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 82.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 88.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 87.04, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 89.42, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 89.42, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 149.78, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 87.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 150.47, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 87.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 153.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 90.28, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 192.6, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 90.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 24.29, "maximum": 230.4, "gross_charge": 256.0, "discounted_cash": 97.48, "setting": "both", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 141.87, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "standard_charge_dollar": 102.91, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "standard_charge_dollar": 128.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "standard_charge_dollar": 150.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "standard_charge_dollar": 128.0, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 92.16, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "standard_charge_dollar": 150.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "standard_charge_dollar": 150.52, "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "standard_charge_dollar": 128.0, "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 44.01, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 44.01, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 97.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "standard_charge_dollar": 82.43, "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 88.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "standard_charge_dollar": 87.04, "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 89.42, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 89.42, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "standard_charge_dollar": 149.78, "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 87.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 150.47, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 87.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "standard_charge_dollar": 153.6, "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 90.28, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 192.6, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 90.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 91.48, "maximum": 91.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 91.48, "maximum": 91.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 91.48, "maximum": 91.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 91.48, "maximum": 91.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 91.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.24, "maximum": 9.5, "discounted_cash": 6.65, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 7.0, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "standard_charge_dollar": 6.13, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "standard_charge_dollar": 6.13, "methodology": "fee schedule"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 4.45, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}, {"code": "891", "type": "RC"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}, {"code": "892", "type": "RC"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "Drug FS #13100 at 100%", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY NOT W/EXTRACTS", "code_information": [{"code": "D7321", "type": "HCPCS"}], "standard_charges": [{"minimum": 1443.09, "maximum": 3232.52, "discounted_cash": 2777.4, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2381.1, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 2777.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_charge_dollar": 1486.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Clover Insurance Company", "plan_name": "HMO MA", "standard_charge_dollar": 1500.81, "methodology": "fee schedule"}, {"payer_name": "Clover Insurance Company", "plan_name": "PPO MA", "standard_charge_dollar": 1500.81, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "HMO MA", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Devoted Health Plan", "plan_name": "PPO MA", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Medcost - SC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.51, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "MMP", "standard_charge_dollar": 1471.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Marketplace", "standard_charge_dollar": 2525.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1471.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Phcs", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Plotkin Health", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "MMP", "standard_charge_dollar": 1515.24, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Marketplace", "standard_charge_dollar": 3232.52, "methodology": "fee schedule"}, {"payer_name": "Select Health", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.34, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Select Health", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1515.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "All Other Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Exchange", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Options PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY W/EXTRACT 1-3", "code_information": [{"code": "D7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 1443.09, "maximum": 3232.52, "discounted_cash": 2071.07, "setting": "outpatient", "payers_information": [{"payer_name": "Absolute Total Care", "plan_name": "MMP", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Marketplace", "standard_charge_dollar": 2381.1, "methodology": "fee schedule"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 26.61, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Absolute Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "ACA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "ASA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Aetna Whole Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "FH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1443.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "NAP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 58.8, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Non-Par Products of APCN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Blue Option HIX (BCBO)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Choice Health Plan Commercial (BCHP)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Blue Cross Blue Essentials HIX (BCBE)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 16.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "Preferred Blue Commercial (PB)", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BlueCross BlueShield of South Carolina", "plan_name": "State Health Plan", "standard_charge_dollar": 2071.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "HMOOPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "HealthSpring", "standard_ch